Provider Demographics
NPI:1235942111
Name:SUMMERVILLE, MELVIN SR
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:SUMMERVILLE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 SMOKEHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-8561
Mailing Address - Country:US
Mailing Address - Phone:901-596-3934
Mailing Address - Fax:
Practice Address - Street 1:1683 SMOKEHOUSE DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-8561
Practice Address - Country:US
Practice Address - Phone:901-596-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle