MEDICARE: SUMMIT MEDICAL GROUP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1043399686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	1275 DICK LONAS RD UNIT 101
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1383
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:	865-584-1363

Provider Business Practice Location Address
First Line	:	2125 W EMORY RD
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-3704
Country	:	US
Telephone Number	:	865-938-5911
Fax Number	:	865-938-5924

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	ED CURTIS
Credential	:
Telephone Number	:	865-584-4747

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	12/27/2022

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Directions to “SUMMIT MEDICAL GROUP, PLLC ” Practice Location

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