Provider Demographics
NPI:1194513663
Name:ROUNTREE, CLAYTON REESE
Entity type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:REESE
Last Name:ROUNTREE
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 1:118 THRUSH ST
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-6818
Mailing Address - Country:US
Mailing Address - Phone:229-947-8479
Mailing Address - Fax:
Practice Address - Street 1:245 COUNTRY CLUB DR BLDG 100A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7216
Practice Address - Country:US
Practice Address - Phone:470-878-1359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor