Dominique Dessausure, CHIROPRACTOR

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR010315 Issued in GA

Practice address

2375 Wall St SE
Conyers, GA 30013-6702

Phone

(404) 947-8262

NPI assigned

Dec 30, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: dominique.dessausure.p1@direct.aicaorthopedics.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1154960763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 WALL ST SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 WALL ST SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136702",
            "telephone_number": "404-947-8262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3858 Cameron Trl SE",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300132287",
            "country_code": "US",
            "telephone_number": "404-408-7262",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2375 Wall St SE Ste 135",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300132290",
            "country_code": "US",
            "telephone_number": "404-408-7262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESSAUSURE",
        "first_name": "DOMINIQUE",
        "name_prefix": "Dr.",
        "credential": "CHIROPRACTOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-30",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR010315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Conyers, GA
• Providers in Conyers, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.