Provider Demographics
NPI:1003860982
Name:WITHERSPOON, CHRISTI A (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:A
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:325 OLD PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4493
Practice Address - Country:US
Practice Address - Phone:629-255-2100
Practice Address - Fax:629-255-4168
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3861880Medicaid
TN3861880Medicaid
TNH32713Medicare UPIN
TN103I117090Medicare PIN
TN4010254OtherBCBS
TN4010254OtherTENNCARE
TN110224008OtherR/R MEDICARE
TNP2710633OtherFIRST HEALTH
TN3861881Medicare PIN
TNH32713Medicare UPIN