Individual
CHARLES M WILLIAMSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, ATC
Contact information
Practice address
48 FOREST RDG, PETAL, MS 39465-5938
(601) 584-9001
Mailing address
48 FOREST RDG, PETAL, MS 39465-5938
(601) 584-9001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0963
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09170323
—
MS
01
—
7963405
AETNA
MS
Enumeration date
08/30/2006
Last updated
06/14/2022
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