Provider Demographics
NPI:1841253754
Name:HAWKINS, STEPHEN SMITH (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SMITH
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 1:1000 EAST THIRD STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-4115
Mailing Address - Country:US
Mailing Address - Phone:423-664-5165
Mailing Address - Fax:423-664-5164
Practice Address - Street 1:1000 EAST THIRD STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-4115
Practice Address - Country:US
Practice Address - Phone:423-664-5165
Practice Address - Fax:423-664-5164
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN009456207RI0200X
GA028006207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3185106Medicaid
LA1734349OtherLOUISIANA MEDICAID
TN621726531002OtherCIGNA
TN0005478016OtherAETNA
1891884292OtherGROUP N P I
TN3081724OtherBLUE CROSS
NC5902599OtherNORTH CAROLINA MEDICAID
GA00304213CMedicaid
TN621726531002OtherCIGNA
NC5902599OtherNORTH CAROLINA MEDICAID
TN3185101Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE