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General NPI Number Information
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NPI Number | 1023786753
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Entity Type | Individual
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Provider Name | JAMES E WITHERSPOON IV CCEMT-P, CCHW
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Gender | Male
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 400 WEST AIRPORT BLVD CIMHS
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City | SANFORD
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State | FL
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Zip | 32773
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Country | US
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Telephone | 407-665-3220
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Fax |
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Provider Business Mailing Address
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Address Line | 400 WEST AIRPORT BLVD CIMHS
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City | SANFORD
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State | FL
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Zip | 32773
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Country | US
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Telephone | 407-665-3220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | PMD509708
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | CCHW100372
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License Number State | FL
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