Provider Demographics
NPI:1639792245
Name:SUMMIT HEALTH PSYCHIATRY, PC
Entity Type:Organization
Organization Name:SUMMIT HEALTH PSYCHIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:828-273-0162
Mailing Address - Street 1:226 SHANNON RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-8739
Mailing Address - Country:US
Mailing Address - Phone:828-273-0162
Mailing Address - Fax:
Practice Address - Street 1:226 SHANNON RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-8739
Practice Address - Country:US
Practice Address - Phone:828-273-0162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC103720OtherMEDICAL LICENSE