Provider Demographics
NPI:1023786753
Name:WITHERSPOON, JAMES E IV (CCEMT-P, CCHW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:WITHERSPOON
Suffix:IV
Gender:M
Credentials:CCEMT-P, CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WEST AIRPORT BLVD
Mailing Address - Street 2:CIMHS
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773
Mailing Address - Country:US
Mailing Address - Phone:407-665-3220
Mailing Address - Fax:
Practice Address - Street 1:400 WEST AIRPORT BLVD
Practice Address - Street 2:CIMHS
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773
Practice Address - Country:US
Practice Address - Phone:407-665-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
FLPMD509708146L00000X
FLCCHW100372172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No174H00000XOther Service ProvidersHealth Educator
No172V00000XOther Service ProvidersCommunity Health Worker