Basic Information
| Provider Information | |||||||||
| NPI: | 1679593339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARCHER | ||||||||
| FirstName: | E | ||||||||
| MiddleName: | WYMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 406153 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303841876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735842098 | ||||||||
| FaxNumber: | 9735842106 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 SUNSET STRIP | ||||||||
| Address2: | |||||||||
| City: | SUCCASUNNA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078761311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735842098 | ||||||||
| FaxNumber: | 9735842106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 01/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 25MG00003100 | NJ | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.