Provider Demographics
NPI:1962722041
Name:HAWKINS, ILIANA DIAZ (CSA)
Entity type:Individual
Prefix:MRS
First Name:ILIANA
Middle Name:DIAZ
Last Name:HAWKINS
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Gender:F
Credentials:CSA
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Mailing Address - Street 1:3450 ACWORTH DUE WEST RD NW
Mailing Address - Street 2:BLDG 200 STE 220
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1001
Mailing Address - Country:US
Mailing Address - Phone:770-794-6643
Mailing Address - Fax:770-794-6683
Practice Address - Street 1:3450 ACWORTH DUE WEST RD NW
Practice Address - Street 2:BLDG 200 STE 220
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1001
Practice Address - Country:US
Practice Address - Phone:770-794-6643
Practice Address - Fax:770-794-6683
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2021-06-02
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Provider Licenses
StateLicense IDTaxonomies
363AS0400X
VA3395246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist