Individual provider Active NPI

James L Goodbread, D.C.

  • Chiropractor
  • Lilburn, GA
National Provider Identifier
1962446492
Registry record updated Apr 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR007679 Issued in GA
Practice address
4566 Lawrenceville Hwy NW
Suite 201
Lilburn, GA 30047-3642
Phone
(770) 923-3707
Fax
(770) 923-4170
NPI assigned
Jun 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIR007679 GA Primary

Addresses

Primary practice location

4566 Lawrenceville Hwy NW
Suite 201
Lilburn, GA 30047-3642

Mailing address

4566 Lawrenceville Hwy NW
Suite 201
Lilburn, GA 30047-3642
Phone (770) 923-3707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050823000281 GA Practitioner - Chiropractic 1052342755 Practice locations: Lilburn, GA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIR007679GAMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427932800000",
    "number": "1962446492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4566 LAWRENCEVILLE HWY NW",
            "address_2": "SUITE 201",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473642",
            "telephone_number": "770-923-3707",
            "fax_number": "770-923-4170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4566 LAWRENCEVILLE HWY NW",
            "address_2": "SUITE 201",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473642",
            "telephone_number": "770-923-3707",
            "fax_number": "770-923-4170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODBREAD",
        "first_name": "JAMES",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2015-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR007679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lilburn, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.