Healthcare Provider Details

I. General information

NPI: 1538260732
Provider Name (Legal Business Name): JAMES WITHAM JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 HIGHWAY 51 S
COVINGTON TN
38019-3635
US

IV. Provider business mailing address

PO BOX 1000 DEPT 931
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-475-4550
  • Fax:
Mailing address:
  • Phone: 901-382-1200
  • Fax: 901-382-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000009553
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: