Provider Demographics
NPI:1700075074
Name:WILLIAM E. ROUNDTREE M.D.,P.C.
Entity Type:Organization
Organization Name:WILLIAM E. ROUNDTREE M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:ROUNDTREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-324-3650
Mailing Address - Street 1:1716 BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-3003
Mailing Address - Country:US
Mailing Address - Phone:706-324-3650
Mailing Address - Fax:706-324-7510
Practice Address - Street 1:1716 BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3003
Practice Address - Country:US
Practice Address - Phone:706-324-3650
Practice Address - Fax:706-324-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA537001OtherCLAIM BILLING ID
GA00346321BMedicaid
GAC75484OtherUPIN
GAC75484OtherUPIN