Healthcare Provider Details

I. General information

NPI: 1679996052
Provider Name (Legal Business Name): SUMMER HEALTH & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3106 SUMMER AVE
MEMPHIS TN
38112-2436
US

IV. Provider business mailing address

3106 SUMMER AVE
MEMPHIS TN
38112-2436
US

V. Phone/Fax

Practice location:
  • Phone: 901-320-1027
  • Fax: 901-320-1028
Mailing address:
  • Phone: 901-320-1027
  • Fax: 901-320-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA RUSSELL
Title or Position: MANAGER
Credential:
Phone: 615-400-0553