Provider Demographics
NPI:1205906955
Name:ROUNTREE, RHONDA LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:LYNN
Last Name:ROUNTREE
Suffix:
Gender:F
Credentials:NP-C
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 4363
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4363
Mailing Address - Country:US
Mailing Address - Phone:478-787-4266
Mailing Address - Fax:478-787-4199
Practice Address - Street 1:770 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7307
Practice Address - Country:US
Practice Address - Phone:478-787-4266
Practice Address - Fax:478-787-4199
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN105840163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA048613450AOtherPEACH STATE
GA048613450AMedicaid