Provider Demographics
NPI:1144580473
Name:CARROLL ROSE, MD
Entity type:Organization
Organization Name:CARROLL ROSE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-626-4288
Mailing Address - Street 1:PO BOX 1679
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37825-1679
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6188
Practice Address - Street 1:1610 TAZEWELL RD
Practice Address - Street 2:STE 301
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3600
Practice Address - Country:US
Practice Address - Phone:423-626-4288
Practice Address - Fax:423-626-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty