Provider Demographics
NPI:1992715791
Name:HAWKINS, SAMUEL GREGORY (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GREGORY
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1815 SOMERVILLE SERD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-5015
Mailing Address - Country:US
Mailing Address - Phone:256-353-5600
Mailing Address - Fax:256-351-8006
Practice Address - Street 1:1823 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5015
Practice Address - Country:US
Practice Address - Phone:256-355-2275
Practice Address - Fax:256-301-1240
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000091741Medicaid
AL51091741OtherBCBS OF AL
AL51091741OtherBCBS OF AL
AL830369114OtherTAX ID NUMBER