Provider Demographics
NPI:1134445992
Name:WEARY, SUMMER R (DPM)
Entity type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:R
Last Name:WEARY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22463
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422-2463
Mailing Address - Country:US
Mailing Address - Phone:931-559-3668
Mailing Address - Fax:
Practice Address - Street 1:503 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1707
Practice Address - Country:US
Practice Address - Phone:931-559-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN726213ES0103X
OH36.003590213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN726OtherTENNESSE STATE PODIATRIC LICENSE
OH36.003590OtherSTATE OF OHIO