Healthcare Provider Details

I. General information

NPI: 1568526051
Provider Name (Legal Business Name): LOYD WILLIAM WITHERSPOON JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 GUNBARREL RD SUITE 300
CHATTANOOGA TN
37421-7174
US

IV. Provider business mailing address

5000 W ESPLANADE AVE PMB 235
METAIRIE LA
70006-2551
US

V. Phone/Fax

Practice location:
  • Phone: 423-499-6488
  • Fax: 423-855-4100
Mailing address:
  • Phone: 504-779-8120
  • Fax: 504-779-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM380
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: