Basic Information
| Provider Information | |||||||||
| NPI: | 1417377102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAWKEN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | NELSON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2704 HENRY ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274053633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366635700 | ||||||||
| FaxNumber: | 3366635734 | ||||||||
| Practice Location | |||||||||
| Address1: | 2704 HENRY ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274053633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366635700 | ||||||||
| FaxNumber: | 3366635734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 2021-02136 | NC | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.