Organization
SUMMIT MEDICAL GROUP PLLC
Active
Parent organization
SUMMIT MEDICAL GROUP PLLC
Other names
Hometown Pediatric Jefferson City
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUMMIT MEDICAL GROUP PLLC
Authorized official
SANDRA DEE BOWLES (PROVIDER ENROLLMENT COORDINATOR)
(865) 584-4747
Entity
Organization
Contact information
Practice address
123 MOSSY CREEK DRIVE, JEFFERSON CITY, TN 37760-2410
(865) 475-5377
Mailing address
1275 DICK LONAS RD UNIT 101, KNOXVILLE, TN 37909-1383
(865) 584-4747
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
03/03/2025
Last updated
03/27/2025
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