Provider Demographics
NPI:1669333191
Name:HAWTHORNE, ANTONIO ANTWAN I
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:ANTWAN
Last Name:HAWTHORNE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 AIRWAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5839
Mailing Address - Country:US
Mailing Address - Phone:662-448-3232
Mailing Address - Fax:662-490-3723
Practice Address - Street 1:7300 AIRWAYS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5839
Practice Address - Country:US
Practice Address - Phone:662-448-3232
Practice Address - Fax:662-490-3723
Is Sole Proprietor?:No
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician