Healthcare Provider Details

I. General information

NPI: 1265172456
Provider Name (Legal Business Name): ROSWALDO VILCHEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 REDMOND RD NW
ROME GA
30165-1415
US

IV. Provider business mailing address

501 REDMOND RD NW
ROME GA
30165-1415
US

V. Phone/Fax

Practice location:
  • Phone: 706-766-0386
  • Fax: 706-802-3912
Mailing address:
  • Phone: 706-766-0386
  • Fax: 706-802-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number112662
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: