Basic Information
| Provider Information | |||||||||
| NPI: | 1043363716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWK | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 PRINCE AVE | ||||||||
| Address2: | BUILDING 8A | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306065908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063531630 | ||||||||
| FaxNumber: | 7065436825 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 PRINCE AVE | ||||||||
| Address2: | BUILDING 8A | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306065908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063531630 | ||||||||
| FaxNumber: | 7065436825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 04/02/2014 | ||||||||
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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 | 208600000X | 019390 | GA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 341986 | 01 | GA | WELLCARE | OTHER | 408023018 | 01 | GA | RAIL ROAD MEDICARE PROV# | OTHER | 52004391 | 01 | GA | BLUE CROSS AND BLUE SHIEL | OTHER | 10058985 | 01 | GA | AMERIGROUP | OTHER | 000185039A | 05 | GA | MEDICAID | 000185039B | 05 | GA | MEDICAID |