Healthcare Provider Details

I. General information

NPI: 1881699700
Provider Name (Legal Business Name): CAROLYN ANN ROSS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLYN ANN DURHAM

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WALNUT COMMONS LN STE B
COOKEVILLE TN
38501
US

IV. Provider business mailing address

1400 DEVONSHIRE DR
COLUMBIA SC
29204-2318
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-2557
  • Fax: 931-526-2559
Mailing address:
  • Phone: 931-267-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1416
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: