Healthcare Provider Details

I. General information

NPI: 1023272887
Provider Name (Legal Business Name): BRUTUS ROLAND ROSE RT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MCCALLIE AVE
CHATTANOOGA TN
37404-2934
US

IV. Provider business mailing address

1301 MCCALLIE AVE
CHATTANOOGA TN
37404-2934
US

V. Phone/Fax

Practice location:
  • Phone: 423-622-7212
  • Fax:
Mailing address:
  • Phone: 423-622-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: