Provider Demographics
NPI:1407820749
Name:ROUNDS, JOHN CARSON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CARSON
Last Name:ROUNDS
Suffix:
Gender:M
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:335 N CASWELL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2403
Practice Address - Country:US
Practice Address - Phone:704-384-7980
Practice Address - Fax:704-384-7985
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8973481Medicaid
2171337BMedicare ID - Type Unspecified
NC2171337BMedicare PIN
NC8973481Medicaid