Basic Information
| Provider Information | |||||||||
| NPI: | 1720044548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWKINS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1901 | ||||||||
| Address2: | |||||||||
| City: | STUTTGART | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721601901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706737211 | ||||||||
| FaxNumber: | 8706726823 | ||||||||
| Practice Location | |||||||||
| Address1: | 1609 N MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | STUTTGART | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721603274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706737211 | ||||||||
| FaxNumber: | 8706726823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E3906 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 152572001 | 05 | AR | MEDICAID | 129734729 | 05 | AR | MEDICAID | 100907002 | 05 | AR | MEDICAID | 136428729 | 05 | AR | MEDICAID | 129735729 | 05 | AR | MEDICAID | E3906 | 01 | AR | LICENSE | OTHER |