Healthcare Provider Details

I. General information

NPI: 1205270568
Provider Name (Legal Business Name): SUMNER PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BIG STATION CAMP BLVD
GALLATIN TN
37066-8464
US

IV. Provider business mailing address

PO BOX 336
GALLATIN TN
37066-0336
US

V. Phone/Fax

Practice location:
  • Phone: 615-328-3380
  • Fax: 615-328-3381
Mailing address:
  • Phone: 615-328-3380
  • Fax: 615-328-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000