Provider Demographics
NPI:1487745691
Name:SUMMERS, JONATHAN ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALLEN
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1829 DARBY DR STE A
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2622
Mailing Address - Country:US
Mailing Address - Phone:256-349-5496
Mailing Address - Fax:256-349-5497
Practice Address - Street 1:1829 DARBY DR STE A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2622
Practice Address - Country:US
Practice Address - Phone:256-349-5496
Practice Address - Fax:256-349-5497
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD41411207Q00000X
ALMD28080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN444002Medicare ID - Type Unspecified