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General NPI Number Information
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NPI Number | 1790821460
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Entity Type | Organization
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Legal Business Name | SUSAN WEAVER HAWN, MD, LLC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 85 MEMORIAL DR
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City | JEFFERSON
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State | GA
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Zip | 30549-1257
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Country | US
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Telephone | 706-367-7621
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Fax | 706-367-2192
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Provider Business Mailing Address
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Address Line | PO BOX 820
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City | JEFFERSON
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State | GA
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Zip | 30549-0820
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Country | US
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Telephone | 706-367-7621
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Fax | 706-367-2192
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN W HAWN
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Credential | MD
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Telephone | 706-367-7621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 037562
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License Number State | GA
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