Provider Demographics
NPI:1457353724
Name:HAWES, DIANE FULLER (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:FULLER
Last Name:HAWES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 GLOUCESTERSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-2708
Mailing Address - Country:US
Mailing Address - Phone:336-760-0287
Mailing Address - Fax:
Practice Address - Street 1:UNCG, ANNA GOVE STUDENT HEALTH CENTER
Practice Address - Street 2:GRAY DRIVE
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27402-6170
Practice Address - Country:US
Practice Address - Phone:336-334-5340
Practice Address - Fax:336-334-5343
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC26544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC81453Medicare UPIN