Healthcare Provider Details

I. General information

NPI: 1235336777
Provider Name (Legal Business Name): KATHLEEN HOLLIS HAMMONDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN HOLLIS FREEMAN MD

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4868 BRIDGE RD STE 370
SUFFOLK VA
23435-2048
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-966-2529
  • Fax: 757-942-9895
Mailing address:
  • Phone: 757-966-2629
  • Fax: 757-942-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101247625
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116019609
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number4301111818
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: