Provider Demographics
NPI:1922272897
Name:SUMMITT, ELMER R JR
Entity Type:Individual
Prefix:
First Name:ELMER
Middle Name:R
Last Name:SUMMITT
Suffix:JR
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 1:916 LAFAYETTE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-2071
Mailing Address - Country:US
Mailing Address - Phone:706-866-6600
Mailing Address - Fax:706-866-6665
Practice Address - Street 1:916 LAFAYETTE RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-2071
Practice Address - Country:US
Practice Address - Phone:706-866-6600
Practice Address - Fax:706-866-6665
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHWH001788332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA132 109-0001Medicare PIN