Derryl S. Dickerson, DC, PTA

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

CHIR010363 Issued in GA

Practice address

2850 Johnson Ferry Rd Ste 150
Marietta, GA 30062-8317

Phone

(770) 518-8786

NPI assigned

Aug 31, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Bridge Chiropractic and Rehabilitation LLC

  • Chiropractor
  • Marietta, GA
  • NPI 1548867047
  Medicare reassignment NPD Authorized official
• Genesis Sports Medicine and Rehabilitation, LLC

  • Physical Therapy Clinic/Center
  • Atlanta, GA
  • NPI 1861600520
  NPD (past)
• Susan H Starr DC, PC

  • Chiropractor
  • Marietta, GA
  • NPI 1073866125
  NPD (past)

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1316253107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 WINDCLIFF DR SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300673801",
            "telephone_number": "256-225-0495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 JOHNSON FERRY RD STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628317",
            "telephone_number": "770-518-8786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3890 Redwine Rd SW",
            "address_2": "Suite 114",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303315582",
            "country_code": "US",
            "telephone_number": "404-344-7880",
            "fax_number": "404-344-7881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "DERRYL",
        "middle_name": "S.",
        "credential": "DC, PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-31",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA002699",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "GA",
            "license": "CHIR010363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marie Diaz
• Valerie Diaz
• Daniel Dibacco, PHARMD
• Kelsey Dicaprio
• Abby D Dickenson, APRN
• Tamara Dickerson Dickerson, AA-C
• Ramona Dickey, DPT
• Demetrius Leutrel Dicks, M.D.
• Alexa Anne Dickson, FNP
• Mark W Diehl, M.D.

• Rehabilitation Chiropractor in Marietta, GA
• Providers in Marietta, GA by specialty
• Rehabilitation Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.