Provider Demographics
NPI:1306005137
Name:ROSS, CHARLES AARON (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:AARON
Last Name:ROSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:320 WYNFIELD CT
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2900
Mailing Address - Country:US
Mailing Address - Phone:423-247-2263
Mailing Address - Fax:423-246-1943
Practice Address - Street 1:1335 E CENTER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2489
Practice Address - Country:US
Practice Address - Phone:423-247-2263
Practice Address - Fax:423-434-0818
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I082864Medicare PIN