Provider Demographics
NPI:1528236973
Name:HAMMONS, PATRICIA
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 DULING AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4008
Mailing Address - Country:US
Mailing Address - Phone:601-362-6675
Mailing Address - Fax:601-362-5767
Practice Address - Street 1:661 DULING AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4008
Practice Address - Country:US
Practice Address - Phone:601-362-6675
Practice Address - Fax:601-362-5767
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS159658156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5640700001Medicare NSC