Healthcare Provider Details

I. General information

NPI: 1578095824
Provider Name (Legal Business Name): PHILLIP KYLE SUMMERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 COWART ST STE 321
CHATTANOOGA TN
37408-1179
US

IV. Provider business mailing address

1405 COWART ST STE 321
CHATTANOOGA TN
37408-1179
US

V. Phone/Fax

Practice location:
  • Phone: 423-551-8346
  • Fax:
Mailing address:
  • Phone: 423-551-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number4771
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: