Healthcare Provider Details

I. General information

NPI: 1215269873
Provider Name (Legal Business Name): JOSLYN NICOLE WITHERSPOON M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W. GRAND BOULEVARD HENRY FORD HOSPITAL
DETROIT MI
48202-2608
US

IV. Provider business mailing address

80 JESSE HILL JR DR SE # 26019
ATLANTA GA
30303-3031
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-1601
  • Fax: 313-916-8843
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number4301088338
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301088338
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: