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General NPI Number Information
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NPI Number | 1427276229
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Entity Type | Individual
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Provider Name | ANDREA BROYLES HAWK M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 409 COLEMAN BLVD SUITE 1-A
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-4391
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Country | US
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Telephone | 843-324-5503
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Fax |
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Provider Business Mailing Address
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Address Line | 409 COLEMAN BLVD SUITE 1-A
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-4391
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Country | US
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Telephone | 843-324-5503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2007-00219
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License Number State | NC
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