Provider Demographics
NPI:1689298184
Name:ARCHER, CORI MIZELL (M ED)
Entity Type:Individual
Prefix:MS
First Name:CORI
Middle Name:MIZELL
Last Name:ARCHER
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 WISTERIA LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3488
Mailing Address - Country:US
Mailing Address - Phone:501-545-3837
Mailing Address - Fax:
Practice Address - Street 1:3690 WISTERIA LN SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3488
Practice Address - Country:US
Practice Address - Phone:501-545-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency