Provider Demographics
NPI:1902296064
Name:HAWKINS, KELLY (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409
Mailing Address - Country:US
Mailing Address - Phone:423-821-0038
Mailing Address - Fax:423-825-6346
Practice Address - Street 1:3801 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409
Practice Address - Country:US
Practice Address - Phone:423-821-0038
Practice Address - Fax:423-825-6346
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10667183500000X
GA14047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist