Provider Demographics
NPI:1639585219
Name:ARCHER HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:ARCHER HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTACT PERSON
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OFORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-376-0986
Mailing Address - Street 1:6050 PEACHTREE PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3337
Mailing Address - Country:US
Mailing Address - Phone:912-376-0986
Mailing Address - Fax:678-374-4252
Practice Address - Street 1:6050 PEACHTREE PKWY STE 240
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3337
Practice Address - Country:US
Practice Address - Phone:912-376-0986
Practice Address - Fax:678-374-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========Other9123760986