Active NPI
James Raymond Soetebeer, D.C., M.S.
- Sports Physician Chiropractor
- Smyrna, GA
National Provider Identifier
1730375205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 007573
- Practice address
- 1154 Concord Rd SE
Smyrna, GA 30080-4263 - Phone
- (770) 899-8830
- NPI assigned
- Sep 19, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 007573 | GA | Primary |
Addresses
Primary practice location
1154 Concord Rd SE
Smyrna, GA 30080-4263
Mailing address
1154 Concord Rd SE
Smyrna, GA 30080-4263
Phone (770) 899-8830
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007573 | GA | MD | Sports Physician Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190160000000",
"number": "1730375205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1154 CONCORD RD SE",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300804263",
"telephone_number": "770-899-8830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1154 CONCORD RD SE",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300804263",
"telephone_number": "770-899-8830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOETEBEER",
"first_name": "JAMES",
"middle_name": "RAYMOND",
"name_prefix": "Dr.",
"credential": "D.C., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-19",
"last_updated": "2007-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "GA",
"license": "007573",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smyrna, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.