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Contact Information

ARCHIE J CHAMPION III, PA-C
3301 FIRST STREET EAST
SUITE A
VIDALIA, GA30474
 Phone: 912-537-4411
 Fax: 912-538-8485
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for ARCHIE J CHAMPION III · (Male)

NPI Number 1710944681
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 04/26/2006
Last updated 07/29/2010 - About 16 years ago
Sole proprietor 1 No
Identifiers
  • GA License # 003747
  • GA Medicaid 019893311A
Hospital affiliation(s)
  • MEADOWS REGIONAL MEDICAL CENTER - (Acute Care)
    ONE MEADOWS PARKWAY
    VIDALIA, GA 30474
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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