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General NPI Number Information
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NPI Number | 1144580473
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Entity Type | Organization
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Legal Business Name | CARROLL ROSE, MD
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 1610 TAZEWELL RD STE 301
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City | TAZEWELL
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State | TN
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Zip | 37879-3600
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Country | US
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Telephone | 423-626-4288
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Fax | 423-626-1101
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Provider Business Mailing Address
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Address Line | PO BOX 1679
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City | NEW TAZEWELL
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State | TN
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Zip | 37825-1679
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Country | US
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Telephone | 865-670-6199
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Fax | 865-670-6188
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Authorized Official
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Title or Position | OWNER
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Name | CARROLL E. ROSE
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Credential | MD
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Telephone | 423-626-4288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | TN
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