Provider Demographics
NPI:1952367435
Name:SUMMERS, ROLAND STEVEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROLAND
Middle Name:STEVEN
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 EISENHOWER DR
Mailing Address - Street 2:510 CENTRAL PARK
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1600
Mailing Address - Country:US
Mailing Address - Phone:912-354-5734
Mailing Address - Fax:912-353-9752
Practice Address - Street 1:340 EISENHOWER DR
Practice Address - Street 2:510 CENTRAL PARK
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1600
Practice Address - Country:US
Practice Address - Phone:912-354-5734
Practice Address - Fax:912-353-9752
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014755174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00020798GMedicaid
GA11BDQTQMedicare ID - Type Unspecified
GA00020798GMedicaid