Individual
MR. ARCHIE JOEL CHAMPION III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3301 FIRST STREET EAST, SUITE A, VIDALIA, GA 30474
(912) 537-4411
(912) 538-8485
Mailing address
3301 FIRST STREET EAST, SUITE A, VIDALIA, GA 30474
(912) 537-4411
(912) 538-8485
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003747
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019893311A
—
GA
Enumeration date
04/26/2006
Last updated
07/29/2010
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