Healthcare Provider Details

I. General information

NPI: 1073422333
Provider Name (Legal Business Name): RILEY SUMMER HARLEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RILEY KUBLIN

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 LEXINGTON AVE STE B
SAVANNAH GA
31404-5502
US

IV. Provider business mailing address

409 CHRISTOPHER CT
RINCON GA
31326-9648
US

V. Phone/Fax

Practice location:
  • Phone: 912-303-4200
  • Fax:
Mailing address:
  • Phone: 912-658-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: