Provider Demographics
NPI:1093008039
Name:CARLSON, ANNA ROSE POOLE (MD)
Entity Type:Individual
Prefix:
First Name:ANNA ROSE
Middle Name:POOLE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 READ AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-1228
Mailing Address - Country:US
Mailing Address - Phone:601-954-9697
Mailing Address - Fax:
Practice Address - Street 1:2507 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3304
Practice Address - Country:US
Practice Address - Phone:423-624-4846
Practice Address - Fax:423-624-4847
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51784208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics