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General NPI Number Information
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NPI Number | 1891418232
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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 | 09/21/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 301 GRADY RD
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City | ETOWAH
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State | TN
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Zip | 37331-1924
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Country | US
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Telephone | 423-263-1743
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Fax | 423-263-7723
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Provider Business Mailing Address
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Address Line | 1275 DICK LONAS RD UNIT 101
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City | KNOXVILLE
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State | TN
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Zip | 37909-1383
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Country | US
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Telephone | 865-500-2144
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Fax | 865-584-1363
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ZANDRA M MILLS
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Credential | BSOM, CPCS
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Telephone | 865-500-2144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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