MEDICARE: SUMMIT MEDICAL ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	060141	GA

General Provider Information

NPI Number	:	1629195979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT MEDICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	1874 PIEDMONT AVE NE
Second Line	:	SUITE 500E
City	:	ATLANTA
State	:	GA
Zip	:	30324-4869
Country	:	US
Telephone Number	:	404-607-0042
Fax Number	:	404-607-7086

Provider Business Practice Location Address
First Line	:	1874 PIEDMONT AVE NE
Second Line	:	SUITE 500E
City	:	ATLANTA
State	:	GA
Zip	:	30324-4869
Country	:	US
Telephone Number	:	404-607-0042
Fax Number	:	404-607-7086

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MERRIAM LOUISE MCLENDON
Credential	:
Telephone Number	:	404-607-0042

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/22/2020

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