Healthcare Provider Details

I. General information

NPI: 1528067816
Provider Name (Legal Business Name): JEFFREY SCOTT SUMMERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 MAYNARDVILLE HWY
KNOXVILLE TN
37918-4817
US

IV. Provider business mailing address

6612 MAYNARDVILLE HWY
KNOXVILLE TN
37918-4817
US

V. Phone/Fax

Practice location:
  • Phone: 865-688-1584
  • Fax: 865-688-1581
Mailing address:
  • Phone: 865-688-1584
  • Fax: 865-688-1581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26566
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: