| Brain Restoration Clinic, Pllc | |
|
1040 Edgewater Corp Pkwy Suite 106 Indian Land SC 29707-4514 | |
| (704) 541-9117 | |
| (704) 541-9137 |
| Full Name | Brain Restoration Clinic, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology |
| Location | 1040 Edgewater Corp Pkwy, Indian Land, South Carolina |
| Authorized Official Name and Position | Jean-ronel Corbier (OWNER) |
| Authorized Official Contact | 7045419117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brain Restoration Clinic, Pllc 1040 Edgewater Corp Pkwy Suite 106 Indian Land SC 29707-4514 Ph: (704) 541-9117 | Brain Restoration Clinic, Pllc 1040 Edgewater Corp Pkwy Suite 106 Indian Land SC 29707-4514 Ph: (704) 541-9117 |
| NPI Number | 1871912667 |
|---|---|
| Provider Enumeration Date | 04/09/2014 |
| Last Update Date | 08/05/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871912667 | NPI | - | NPPES |
| 5905648 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0402X | Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology | 200601910 (North Carolina) | Primary |
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