Provider Demographics
NPI:1104533488
Name:KORTMAN, YOLANDA CAMACHO (DC)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:CAMACHO
Last Name:KORTMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 MACY DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6342
Mailing Address - Country:US
Mailing Address - Phone:678-977-6835
Mailing Address - Fax:770-667-8177
Practice Address - Street 1:2302 MACY DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6342
Practice Address - Country:US
Practice Address - Phone:678-977-6835
Practice Address - Fax:770-667-8177
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIRO10879OtherGEORGIA SECRETARY OF STATE