Provider Demographics
NPI:1326396490
Name:ROCHE, WILLIAM PATRICK IV (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:ROCHE
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:389 MULBERRY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7904
Mailing Address - Country:US
Mailing Address - Phone:478-743-9123
Mailing Address - Fax:478-742-9809
Practice Address - Street 1:389 MULBERRY ST STE 200
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-743-9123
Practice Address - Fax:478-742-9809
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2019-05-03
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Provider Licenses
StateLicense IDTaxonomies
GA761522084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology