Provider Demographics
NPI:1548312986
Name:ARCHIE, AURELIUS E (DDS)
Entity type:Individual
Prefix:
First Name:AURELIUS
Middle Name:E
Last Name:ARCHIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3445
Mailing Address - Country:US
Mailing Address - Phone:770-320-8792
Mailing Address - Fax:770-320-8793
Practice Address - Street 1:101 CENTER ST
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3445
Practice Address - Country:US
Practice Address - Phone:770-320-8792
Practice Address - Fax:770-320-8793
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0132651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice