Individual
ROBERT WILLIAM ROETHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4340 KINGS WAY, VALDOSTA, GA 31602-6921
(229) 333-9736
(478) 353-1170
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(229) 333-0225
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
9762
GA
Other
Enumeration date
04/24/2020
Last updated
11/19/2020
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