Champion, Archie Joel

Champion, Archie Joel is an individual health care provider with primary practice located at 3301 First Street East Suite A, Vidalia GA 30474. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Champion, Archie Joel can be contacted via phone (912) 537-4411.

Contact Information

Primary practice address
3301 First Street East Suite A Vidalia GA 30474
Phone: (912) 537-4411
Fax: (912) 538-8485
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 003747 Georgia

Profile Details

NPI number 1710944681
LBN Legal business name Champion, Archie Joel
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2006
Last updated Jul 29th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710944681 NPPES
Georgia MEDICAID 019893311A

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