Basic Information
Provider Information
NPI: 1558378513
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAWKINS
FirstName: LINDSAY
MiddleName: LEE
NamePrefix: MRS.
NameSuffix:  
Credential: AAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1775 W HIBISCUS BLVD STE 215
Address2:  
City: MELBOURNE
State: FL
PostalCode: 329012627
CountryCode: US
TelephoneNumber: 3218373820
FaxNumber: 3218373654
Practice Location
Address1: 531 ROSELANE STREET NW
Address2: SUITE 750
City: MARIETTA
State: GA
PostalCode: 30060
CountryCode: US
TelephoneNumber: 7707940477
FaxNumber: 7707943108
Other Information
ProviderEnumerationDate: 08/02/2006
LastUpdateDate: 01/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367H00000X005025GAY Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 

No ID Information.


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