Provider Demographics
NPI:1427276229
Name:HAWK, ANDREA BROYLES (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:BROYLES
Last Name:HAWK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 COLEMAN BLVD
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4391
Mailing Address - Country:US
Mailing Address - Phone:843-324-5503
Mailing Address - Fax:
Practice Address - Street 1:409 COLEMAN BLVD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4391
Practice Address - Country:US
Practice Address - Phone:843-324-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-002192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry