MEDICARE: DR. KEYACHTTA HAWKINS

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	122300000X	Dentist	11073	NC

General Provider Information

NPI Number	:	1548758394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEYACHTTA HAWKINS

Provider Business Mailing Address
First Line	:	168 REGINA LN
Second Line	:
City	:	HENDERSON
State	:	NC
Zip	:	27537-8435
Country	:	US
Telephone Number	:	252-767-6973
Fax Number	:

Provider Business Practice Location Address
First Line	:	3712 LAWNDALE DR STE D
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-3066
Country	:	US
Telephone Number	:	336-901-9957
Fax Number	:

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

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	02/19/2026

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Directions to “ DR. KEYACHTTA HAWKINS ” Practice Location

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