Provider Demographics
NPI:1467040600
Name:SUMMERS, KEATON
Entity Type:Individual
Prefix:
First Name:KEATON
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 CHAPMAN HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4771
Mailing Address - Country:US
Mailing Address - Phone:865-577-0471
Mailing Address - Fax:
Practice Address - Street 1:10721 CHAPMAN HWY STE 6
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4771
Practice Address - Country:US
Practice Address - Phone:865-577-0471
Practice Address - Fax:865-573-3432
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist