Wilbur Lew Blackman III, MPT
Individual provider Active NPI Physical Therapist · Villa Rica, GA
NPI 1033173000 · NPPES record last updated Oct 27, 2025
Key facts
- NPI
- 1033173000
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT006344 (GA)
- Practice address
- 921 Moores Ferry Rd Ste D
Villa Rica, GA 30180-9706 - Phone
- (678) 840-8881
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Medical College of Georgia School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Independent Physical Therapy of Georgia, LLC
Practice addresses (Care Compare)
1025 E W Connector
Suite 406
Austell, GA 30106-8531
Phone (770) 384-1001
215 Davis Blvd
Bremen, GA 30110-2569
Phone (678) 821-3425
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251226001345 | GA | Practitioner - Physical Therapist in Private Practice | 1951897107 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT006344 | GA | MD | Physical Therapist |
| 416 | GA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlanta South Physical Therapy, Inc | Physical Therapist | Current |
Accepting new patients |
| Independent Physical Therapy of Georgia, LLC | Physical Therapist | Current |
Accepting new patients |
| Agilitas USA Inc | Physical Therapist | Current |
Accepting new patients |
| Agilitas USA, Inc | Physical Therapist | Current |
Accepting new patients |
| Independent Physical Therapy of Georgia, LLC | Physical Therapist | Current |
Accepting new patients |
| Benchmark Physical Therapy, Inc | Current |
Accepting new patients |
Locations
1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568
1025 E West Connector
Ste 406
Austell, GA 30106
Phone (770) 384-1001
7130 Mount Zion Blvd
Ste 9
Jonesboro, GA 30236
Phone (770) 603-5660
921 Moores Ferry Rd
Ste D
Villa Rica, GA 30180
Phone (678) 840-8881
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT006344 | GA | Yes |
| Physical Therapist | 225100000X | 416 | GA |
Addresses
Primary practice location
921 Moores Ferry Rd Ste D
Villa Rica, GA 30180-9706
Mailing address
1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 238-7217
Other practice location 1
812 S Park St
Carrollton, GA 30117-4412
Phone (770) 834-7436
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000918794A | Medicaid | GA |
Other providers in Villa Rica, GA
- Pamela Bertrand
- Better Solutions in Home Healthcare
- Louis Blount Binion
- Bio-Medical Applications of Georgia, Inc.
- BJK Specimen LLC
- Angela Blackshear
- Christina Blair
- Shaketha Blankenship
- Jacob Boateng
- Shandon Boddy
All providers in Villa Rica, GA · Physical Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.