Healthcare Provider Details

I. General information

NPI: 1639080963
Provider Name (Legal Business Name): COLUMBIA ROSE CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 LISCHEY PL
NASHVILLE TN
37207-5937
US

IV. Provider business mailing address

116 AGNES RD STE 200
KNOXVILLE TN
37919-6306
US

V. Phone/Fax

Practice location:
  • Phone: 615-974-9694
  • Fax:
Mailing address:
  • Phone: 615-974-9694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. SYDNEY DANIELLE FERGUSON
Title or Position: OWNER/MANAGING MEMBER
Credential: CCMA, CPT
Phone: 615-974-9694