Provider Demographics
NPI:1063916625
Name:SUMMERS, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 POPLAR AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3835
Mailing Address - Country:US
Mailing Address - Phone:901-347-3972
Mailing Address - Fax:901-907-0299
Practice Address - Street 1:2600 POPLAR AVE STE 112
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3835
Practice Address - Country:US
Practice Address - Phone:901-347-3972
Practice Address - Fax:901-907-0299
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator