Provider Demographics
NPI:1104305382
Name:WILLIAMS, MERCY K
Entity type:Individual
Prefix:MS
First Name:MERCY
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MERCY
Other - Middle Name:K
Other - Last Name:ETHANGATHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:FONDA
Mailing Address - State:NY
Mailing Address - Zip Code:12068-1500
Mailing Address - Country:US
Mailing Address - Phone:518-853-3531
Mailing Address - Fax:518-853-8218
Practice Address - Street 1:20 PARK ST
Practice Address - Street 2:
Practice Address - City:FONDA
Practice Address - State:NY
Practice Address - Zip Code:12068-4830
Practice Address - Country:US
Practice Address - Phone:518-853-3531
Practice Address - Fax:518-853-8218
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management