Individual provider Active NPI

Domineque Ariane Chhun, NP-C

  • Family Nurse Practitioner
  • Smyrna, GA
National Provider Identifier
1275016776
Registry record updated Jan 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
255-839 Issued in GA
Practice address
2670 Cobb Pkwy SE
Smyrna, GA 30080-3014
Phone
(678) 732-1528
NPI assigned
Sep 11, 2018
Last updated
Jan 20, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 255-839 GA Primary

Addresses

Primary practice location

2670 Cobb Pkwy SE
Smyrna, GA 30080-3014

Mailing address

491 Hopkins St SW
Atlanta, GA 30310-1671
Phone (913) 963-1842

Other practice location 1

491 Hopkins St SW
Atlanta, GA 30310-1671
Phone (913) 963-1842

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200420000225 GA Practitioner - Nurse Practitioner 3870923683 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Professional Services LLCGroup PAC ID 8921176231, 171 clinicians

Practice addresses (Care Compare)

2670 Cobb Pkwy SE
Smyrna, GA 30080-3014
Phone (678) 732-1528

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
255-839GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Professional Services, LLC CurrentSince Mar 11, 2020 Accepting new patients
Piedmont Medical Care Corporation Past Accepting new patients

Locations

120 Marietta Hwy
Canton, GA 30114
Phone (678) 732-1406

1267 Highway 54 W
Ste 2200
Fayetteville, GA 30214
Phone (470) 271-3415

2670 Cobb Pkwy SE
Smyrna, GA 30080
Phone (678) 732-1528

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579478400000",
    "number": "1275016776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "491 HOPKINS ST SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303101671",
            "telephone_number": "913-963-1842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2670 COBB PKWY SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300803014",
            "telephone_number": "678-732-1528"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "491 Hopkins St SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303101671",
            "country_code": "US",
            "telephone_number": "913-963-1842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHHUN",
        "first_name": "DOMINEQUE",
        "middle_name": "ARIANE",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "255-839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smyrna, GA

Sources for this page

Verify at the official NPI Registry.