MEDICARE: DR. MONIQUE HAWTHORNE

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1952884249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONIQUE HAWTHORNE

Provider Business Mailing Address
First Line	:	6595 ROSWELL RD
Second Line	:	STE G PMB 4190
City	:	ATLANTA
State	:	GA
Zip	:	30328-1712
Country	:	US
Telephone Number	:	914-815-2848
Fax Number	:

Provider Business Practice Location Address
First Line	:	6595 ROSWELL RD
Second Line	:	STE G PMB 4190
City	:	ATLANTA
State	:	GA
Zip	:	30328-1712
Country	:	US
Telephone Number	:	914-815-2848
Fax Number	:

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

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	10/27/2024

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