Healthcare Provider Details

I. General information

NPI: 1609470962
Provider Name (Legal Business Name): CHAU-KETTIA ARNOLD CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 AUSTIN MEADOWS DR
DECATUR GA
30032-3888
US

IV. Provider business mailing address

1641 AUSTIN MEADOWS DR
DECATUR GA
30032-3888
US

V. Phone/Fax

Practice location:
  • Phone: 678-438-7846
  • Fax:
Mailing address:
  • Phone: 678-438-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: