MEDICARE: JODY SUMRALL

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1417073842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY SUMRALL

Provider Business Mailing Address
First Line	:	PO BOX 444
Second Line	:
City	:	MURPHY
State	:	NC
Zip	:	28906-0444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 VALLEY RIVER AVE
Second Line	:
City	:	MURPHY
State	:	NC
Zip	:	28906-2923
Country	:	US
Telephone Number	:	828-837-0071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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Directions to “ JODY SUMRALL ” Practice Location

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