MEDICARE: COURTNEY CLARK HAWKINS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	112157	GA

General Provider Information

NPI Number	:	1013618719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY CLARK HAWKINS NP

Provider Business Mailing Address
First Line	:	7830 VETERANS PKWY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-4972
Country	:	US
Telephone Number	:	706-320-8881
Fax Number	:	706-221-3594

Provider Business Practice Location Address
First Line	:	7830 VETERANS PKWY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-4972
Country	:	US
Telephone Number	:	706-320-8881
Fax Number	:	706-221-3594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	06/15/2023

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