Healthcare Provider Details

I. General information

NPI: 1720008709
Provider Name (Legal Business Name): JOHN WITHERINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6570 HERONSWOOD DR
MEMPHIS TN
38119-6646
US

IV. Provider business mailing address

PO BOX 17476
MEMPHIS TN
38187-0476
US

V. Phone/Fax

Practice location:
  • Phone: 901-842-1473
  • Fax: 901-844-1439
Mailing address:
  • Phone: 901-842-1473
  • Fax: 901-844-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD0000014835
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD141835
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: