Provider Demographics
NPI:1144918764
Name:WILLIAMS, MERRITT GIBSON II (PT)
Entity type:Individual
Prefix:
First Name:MERRITT
Middle Name:GIBSON
Last Name:WILLIAMS
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ABOARD MCLB ALBANY BUILDING 7000
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31704-0001
Mailing Address - Country:US
Mailing Address - Phone:800-595-5229
Mailing Address - Fax:
Practice Address - Street 1:ABOARD MCLB ALBANY BUILDING 7000
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31704-0001
Practice Address - Country:US
Practice Address - Phone:800-595-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist