Provider Demographics
NPI:1932217999
Name:ROUNDTREE, WILLIAM EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EARL
Last Name:ROUNDTREE
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 1:1716 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:706-576-6548
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:706-576-6548
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021802111NS0005X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00346321BMedicaid
GA00346321BMedicaid
GAC75484Medicare UPIN