Active NPI
Charles M Williamson, PT, ATC
- Physical Therapist
- Petal, MS
National Provider Identifier
1770693582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT0963
- Practice address
- 48 Forest RDG
Petal, MS 39465-5938 - Phone
- (601) 584-9001
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT0963 | MS | Primary |
Addresses
Primary practice location
48 Forest RDG
Petal, MS 39465-5938
Mailing address
48 Forest RDG
Petal, MS 39465-5938
Phone (601) 584-9001
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09170323 | Medicaid | MS | |
| 7963405 | Other | MS | AETNA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mwilliamson2246@directpatientrecord.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT0963 | MS | MD | Physical Therapist |
Interoperability endpoints
- mwilliamson2246@directpatientrecord.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655164800000",
"number": "1770693582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48 FOREST RDG",
"city": "PETAL",
"state": "MS",
"postal_code": "394655938",
"telephone_number": "601-584-9001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "48 FOREST RDG",
"city": "PETAL",
"state": "MS",
"postal_code": "394655938",
"telephone_number": "601-584-9001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMSON",
"first_name": "CHARLES",
"middle_name": "M",
"credential": "PT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2022-06-14",
"certification_date": "2022-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MS",
"license": "PT0963",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09170323",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7963405",
"state": "MS"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mwilliamson2246@directpatientrecord.com",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "103 Medical Park",
"city": "Hattiesburg",
"state": "MS",
"country_code": "US",
"postal_code": "394019042",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Petal, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.