Provider Demographics
NPI:1750265443
Name:HAWKINS, JASON THOMAS
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3965
Mailing Address - Country:US
Mailing Address - Phone:304-687-9510
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:AMHERSTDALE
Practice Address - State:WV
Practice Address - Zip Code:25607
Practice Address - Country:US
Practice Address - Phone:304-687-9510
Practice Address - Fax:304-687-9510
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist