Provider Demographics
NPI:1093921330
Name:SUMMERS, FAYE BURDETTE
Entity Type:Individual
Prefix:MRS
First Name:FAYE
Middle Name:BURDETTE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:FAYE
Other - Middle Name:BURDETTE
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:117 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 N CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1373
Practice Address - Country:US
Practice Address - Phone:205-655-2403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS