Healthcare Provider Details

I. General information

NPI: 1760481451
Provider Name (Legal Business Name): NANCY LUONGO WITHERSPOON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W PRICE RD
DANDRIDGE TN
37725-4524
US

IV. Provider business mailing address

150 W PRICE RD
DANDRIDGE TN
37725-4524
US

V. Phone/Fax

Practice location:
  • Phone: 865-475-6161
  • Fax: 865-475-9857
Mailing address:
  • Phone: 865-475-6161
  • Fax: 865-475-9857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1535
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: