Provider Demographics
NPI:1356057681
Name:SUMMIT MEDICAL GROUP,PLLC
Entity type:Organization
Organization Name:SUMMIT MEDICAL GROUP,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:BSOM, COPCS
Authorized Official - Phone:865-500-2144
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:3103 BUSINESS PARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3676
Practice Address - Country:US
Practice Address - Phone:615-851-7865
Practice Address - Fax:615-851-7853
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT MEDICAL GROUP,PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty