Provider Demographics
NPI:1568722353
Name:HAMMONDS, LARRY (RNFA / CNOR)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:HAMMONDS
Suffix:
Gender:M
Credentials:RNFA / CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720B MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2131
Mailing Address - Country:US
Mailing Address - Phone:228-702-2000
Mailing Address - Fax:228-702-2018
Practice Address - Street 1:1720B MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2131
Practice Address - Country:US
Practice Address - Phone:228-702-2000
Practice Address - Fax:228-702-2018
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867009261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical