Active NPI
Yolanda Camacho Kortman, DC
- Chiropractor
- Roswell, GA
National Provider Identifier
1104533488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 10879
- Practice address
- 2302 Macy Dr
Roswell, GA 30076-6342 - Phone
- (678) 977-6835
- Fax
- (770) 667-8177
- NPI assigned
- Nov 4, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 10879 | GA | Primary |
Addresses
Primary practice location
2302 Macy Dr
Roswell, GA 30076-6342
Mailing address
2302 Macy Dr
Roswell, GA 30076-6342
Phone (678) 977-6835
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CHIRO10879 | Other | GA | GEORGIA SECRETARY OF STATE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10879 | GA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667520000000",
"number": "1104533488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2302 MACY DR",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300766342",
"telephone_number": "678-977-6835",
"fax_number": "770-667-8177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2302 MACY DR",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300766342",
"telephone_number": "678-977-6835",
"fax_number": "770-667-8177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KORTMAN",
"first_name": "YOLANDA",
"middle_name": "CAMACHO",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-04",
"last_updated": "2022-11-04",
"certification_date": "2022-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Chiropractor",
"state": "GA",
"license": "10879",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA SECRETARY OF STATE",
"identifier": "CHIRO10879",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.