Provider Demographics
NPI:1841323920
Name:CHARUKHCHIAN, SAMVEL ARTAVAZOVICH (MD, PHD)
Entity type:Individual
Prefix:
First Name:SAMVEL
Middle Name:ARTAVAZOVICH
Last Name:CHARUKHCHIAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 N HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4241
Mailing Address - Country:US
Mailing Address - Phone:404-327-3700
Mailing Address - Fax:
Practice Address - Street 1:2012 HAROBI DR STE B
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5161
Practice Address - Country:US
Practice Address - Phone:404-477-0400
Practice Address - Fax:404-477-0401
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051918207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology