Healthcare Provider Details
I. General information
NPI: 1053480004
Provider Name (Legal Business Name): SUMMIT MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/06/2006
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
8975 EXECUTIVE PARK DR SUITE 200
KNOXVILLE TN
37923
US
IV. Provider business mailing address
1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US
V. Phone/Fax
- Phone: 865-691-4100
- Fax: 865-691-6178
- Phone: 865-584-4747
- Fax: 865-584-1363
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RR0500X |
| Taxonomy | Rheumatology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
ED
CURTIS
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 865-584-4747