Healthcare Provider Details

I. General information

NPI: 1730375205
Provider Name (Legal Business Name): JAMES RAYMOND SOETEBEER D.C., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 CONCORD RD SE
SMYRNA GA
30080-4263
US

IV. Provider business mailing address

1154 CONCORD RD SE
SMYRNA GA
30080-4263
US

V. Phone/Fax

Practice location:
  • Phone: 770-899-8830
  • Fax:
Mailing address:
  • Phone: 770-899-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number007573
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: