Provider Demographics
NPI:1437312998
Name:DUSSEAULT, BEAU NIXON (MD)
Entity Type:Individual
Prefix:DR
First Name:BEAU
Middle Name:NIXON
Last Name:DUSSEAULT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-428-4475
Mailing Address - Fax:770-426-1499
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 250
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-428-4475
Practice Address - Fax:770-426-1499
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
GA66366208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYFD 2247117OtherDEA