Provider Demographics
NPI:1699348235
Name:ROUNDS, WILLIE J
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:J
Last Name:ROUNDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 CROWDER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-9825
Mailing Address - Country:US
Mailing Address - Phone:662-625-9027
Mailing Address - Fax:
Practice Address - Street 1:1019 CROWDER DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921-9825
Practice Address - Country:US
Practice Address - Phone:662-625-9027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS801090759343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)