Provider Demographics
NPI:1588658181
Name:WITHERSPOON, LAURA E (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:E
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 1:979 E 3RD ST
Mailing Address - Street 2:STE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-267-0466
Mailing Address - Fax:423-493-2370
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:STE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-267-0466
Practice Address - Fax:423-493-2370
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD25602208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020039112OtherRR MEDICARE
1740004OtherUHC
TNQ002564Medicaid
AL150882Medicaid
62165877455OtherJDH
GA00670249BMedicaid
3076751OtherBCBS OF TN
8045925 001OtherCIGNA
8045925 001OtherCIGNA
AL150882Medicaid
F89311Medicare UPIN
F89311Medicare UPIN