| Doctor Name: | MR. CHITCHAWAL SAHATEVASUKONT |
| NPI Number: | 1053661074 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | N.P. |
| License Number: | AP4663 |
| Business Practice Address: | 905 Montgomery St Decorah, IA - 521012325 |
| Business Phone Number: | 7703630793 |
| Business Fax Number: | |
| Mailing Address: | 1920 Variations Dr Ne, ATLANTA |
| State: | GA |
| Postal Code: | 303291009 |
| Phone Number: | 7703630793 |
| Fax Number: | |
| NPI Enumeration Date: | 09/17/2012 |
| NPI Last Update Date: | 10/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | AP4663 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |