Provider Demographics
NPI:1194749648
Name:HAWKINS-RIVERS, SANFORD WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:SANFORD
Middle Name:WILLIAM
Last Name:HAWKINS-RIVERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 TILGHMAN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5509
Mailing Address - Country:US
Mailing Address - Phone:910-892-1550
Mailing Address - Fax:910-892-1992
Practice Address - Street 1:803 TILGHMAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5509
Practice Address - Country:US
Practice Address - Phone:910-892-1550
Practice Address - Fax:910-892-1992
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501926208600000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903407Medicaid
NC1414KOtherBC/BS
NC193562OtherMEDCOST
NC2005-01926OtherNC LICENSE
NC5903407Medicaid
NC2050786AMedicare PIN