Provider Demographics
NPI:1457161861
Name:ROSE, MACEY
Entity type:Individual
Prefix:
First Name:MACEY
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 KNOB RD
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-4705
Mailing Address - Country:US
Mailing Address - Phone:865-227-7470
Mailing Address - Fax:
Practice Address - Street 1:1231 KNOB RD
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861-4705
Practice Address - Country:US
Practice Address - Phone:865-227-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula