Provider Demographics
NPI:1093911422
Name:SCENIC CITY PODIATRY, PLLC
Entity Type:Organization
Organization Name:SCENIC CITY PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOYD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:423-499-6488
Mailing Address - Street 1:1510 GUNBARREL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7174
Mailing Address - Country:US
Mailing Address - Phone:423-499-6488
Mailing Address - Fax:423-855-4100
Practice Address - Street 1:1510 GUNBARREL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7174
Practice Address - Country:US
Practice Address - Phone:423-499-6488
Practice Address - Fax:423-855-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty