Healthcare Provider Details

I. General information

NPI: 1093008039
Provider Name (Legal Business Name): ANNA ROSE POOLE CARLSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 MCCALLIE AVE
CHATTANOOGA TN
37404-3304
US

IV. Provider business mailing address

1618 READ AVE UNIT B
CHATTANOOGA TN
37408-1228
US

V. Phone/Fax

Practice location:
  • Phone: 423-624-4846
  • Fax: 423-624-4847
Mailing address:
  • Phone: 601-954-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51784
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: