MEDICARE: WILLIAM E. ROUNDTREE M.D.,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	021802	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	537001	OTHER	GA	CLAIM BILLING ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C75484	OTHER	GA	UPIN

General Provider Information

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

Provider Business Mailing Address
First Line	:	1716 BUENA VISTA RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-3003
Country	:	US
Telephone Number	:	706-324-3650
Fax Number	:	706-324-7510

Provider Business Practice Location Address
First Line	:	1716 BUENA VISTA RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-3003
Country	:	US
Telephone Number	:	706-324-3650
Fax Number	:	706-324-7510

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. WILLIAM EARL ROUNDTREE
Credential	:	M.D.
Telephone Number	:	706-324-3650

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	03/07/2023

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