NPIMap

Organization Active NPI

Hawthorne Medical Associates PC

  • Internal Medicine Physician
  • Athens, GA
National Provider Identifier
1689636201
Registry record updated Feb 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
HAWTHORNE MEDICAL ASSOCIATES PC
Practice address
120 Hawthorne Park
Athens, GA 30606-2147
Phone
(706) 353-8700
Fax
(706) 353-7228
NPI assigned
Apr 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Shelley D Des Jardines
Title
Practice Administrator
Phone
(706) 769-3331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

120 Hawthorne Park
Athens, GA 30606-2147

Mailing address

120 Hawthorne Park
Athens, GA 30606-2147
Phone (706) 353-8700

Other identifiers 2

IdentifierTypeStateIssuer
CC3389OtherGARAILROAD MEDICARE
06965OtherGABLUE CROSS/BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

1351 Stonebridge Pkwy
Bldg 105
Watkinsville, GA 30677
Phone (706) 433-2019

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266192000000",
    "number": "1689636201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 HAWTHORNE PARK",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062147",
            "telephone_number": "706-353-8700",
            "fax_number": "706-353-7228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HAWTHORNE PARK",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062147",
            "telephone_number": "706-353-8700",
            "fax_number": "706-353-7228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAWTHORNE MEDICAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-06",
        "last_updated": "2010-02-15",
        "status": "A",
        "authorized_official_last_name": "DES JARDINES",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "706-769-3331",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC3389",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "06965",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.