Provider Demographics
NPI:1619152808
Name:CHICKOS, ROSEMARY (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:CHICKOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 E CENTRAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2778
Mailing Address - Country:US
Mailing Address - Phone:423-907-1680
Mailing Address - Fax:423-907-1684
Practice Address - Street 1:919 E CENTRAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2778
Practice Address - Country:US
Practice Address - Phone:423-907-1680
Practice Address - Fax:423-907-1684
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO4138208600000X
NC2012-01416208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ060302Medicaid