Healthcare Provider Details

I. General information

NPI: 1700075074
Provider Name (Legal Business Name): WILLIAM E. ROUNDTREE M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 BUENA VISTA RD
COLUMBUS GA
31906-3003
US

IV. Provider business mailing address

1716 BUENA VISTA RD
COLUMBUS GA
31906-3003
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-3650
  • Fax: 706-324-7510
Mailing address:
  • Phone: 706-324-3650
  • Fax: 706-324-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number021802
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM EARL ROUNDTREE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 706-324-3650