Basic Information
| Provider Information | |||||||||
| NPI: | 1023157229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAWKINS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 WESTCHESTER DR | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022536 | ||||||||
| FaxNumber: | 3368022534 | ||||||||
| Practice Location | |||||||||
| Address1: | 3221 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CLAREMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286109692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284594445 | ||||||||
| FaxNumber: | 8284594434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 01/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 96-01628 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1013T | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 69824 | 01 | NC | MEDCOST | OTHER | 891013T | 05 | NC | MEDICAID |