Provider Demographics
NPI:1598731556
Name:ARCHER, MICHELLE G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:G
Last Name:ARCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-0497
Mailing Address - Country:US
Mailing Address - Phone:803-945-1005
Mailing Address - Fax:803-945-9601
Practice Address - Street 1:99 N MILL ST
Practice Address - Street 2:
Practice Address - City:LITTLE MOUNTAIN
Practice Address - State:SC
Practice Address - Zip Code:29075-8788
Practice Address - Country:US
Practice Address - Phone:803-945-1005
Practice Address - Fax:803-945-9601
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC188781Medicaid
SC188781Medicaid