Individual
DR. JOHN WILLIAM SUMMERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 MEDICAL PARK BLVD, PETERSBURG, VA 23805
(615) 221-4400
Mailing address
5301 VIRGINIA WAY STE 300, BRENTWOOD, TN 37027-7542
(615) 221-4400
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101041829
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006603858
—
VA
Enumeration date
07/29/2005
Last updated
06/10/2019
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