Provider Demographics
NPI:1053572800
Name:ROUNTREE, JUSTIN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LEE
Last Name:ROUNTREE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1497 FAIR RD STE 206
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0824
Mailing Address - Country:US
Mailing Address - Phone:912-486-1141
Mailing Address - Fax:912-871-2483
Practice Address - Street 1:1497 FAIR RD STE 206
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0824
Practice Address - Country:US
Practice Address - Phone:912-486-1141
Practice Address - Fax:912-871-2483
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2012-00569207LP2900X
GA81392207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine