Healthcare Provider Details

I. General information

NPI: 1235937764
Provider Name (Legal Business Name): SUMMIT MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 MIDDLE CREEK RD
SEVIERVILLE TN
37862-5014
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 865-453-9980
  • Fax:
Mailing address:
  • Phone: 865-584-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA DEE BOWLES
Title or Position: PROVIDER ENROLLMENT COORDINATOR
Credential:
Phone: 865-584-4747