Basic Information
Provider Information
NPI: 1467807750
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAWKLAND
FirstName: ROBIN
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 221 TECHNOLOGY PKWY NW
Address2:  
City: ROME
State: GA
PostalCode: 301651369
CountryCode: US
TelephoneNumber: 7062955331
FaxNumber: 7068026151
Practice Location
Address1: 550 REDMOND RD NW
Address2:  
City: ROME
State: GA
PostalCode: 301651416
CountryCode: US
TelephoneNumber: 7062338508
FaxNumber: 7062338509
Other Information
ProviderEnumerationDate: 04/25/2016
LastUpdateDate: 04/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XRN186040GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home