Provider Demographics
NPI:1215104526
Name:HAWKINS, NATHANAEL L (MD)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:L
Last Name:HAWKINS
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 1:5408 BLUE DOG RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6031
Mailing Address - Country:US
Mailing Address - Phone:850-768-0161
Mailing Address - Fax:
Practice Address - Street 1:1360 BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-6303
Practice Address - Country:US
Practice Address - Phone:850-638-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN12420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149SJOtherBCBS
FL002733400Medicaid
FL149SJOtherBCBS