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General NPI Number Information
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NPI Number | 1497371496
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Entity Type | Organization
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Legal Business Name | SUMMIT MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 1031 W MADISON AVE STE 1
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City | ATHENS
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State | TN
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Zip | 37303-3496
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Country | US
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Telephone | 423-745-6575
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 DICK LONAS RD
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City | KNOXVILLE
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State | TN
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Zip | 37909-1382
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Country | US
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Telephone | 865-584-4747
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | ALLISON HALL
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Credential |
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Telephone | 865-584-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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