=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538079033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT MEDICAL GROUP, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2026
-----------------------------------------------------
Last Update Date | 09/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 341 CENTRAL AVE W
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38556-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-879-9892
-----------------------------------------------------
Fax | 833-455-8834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 341 CENTRAL AVE W
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38556-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-879-9892
-----------------------------------------------------
Fax | 833-455-8834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER ENROLLMENT SUPERVISOR
-----------------------------------------------------
Name | JENNIFER RANEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-584-4747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------