Provider Demographics
NPI:1396508495
Name:CHAIYACHATI, KITTIYA
Entity type:Individual
Prefix:
First Name:KITTIYA
Middle Name:
Last Name:CHAIYACHATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 ALLENHURST DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2014
Mailing Address - Country:US
Mailing Address - Phone:678-879-3125
Mailing Address - Fax:
Practice Address - Street 1:3295 RIVER EXCHANGE DR STE 170
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4220
Practice Address - Country:US
Practice Address - Phone:404-500-8264
Practice Address - Fax:470-408-2473
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist