Healthcare Provider Details

I. General information

NPI: 1851088611
Provider Name (Legal Business Name): BRAIN INJURY SOLUTIONS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 PHOENIX BLVD STE 800
ATLANTA GA
30349-5596
US

IV. Provider business mailing address

1720 PHOENIX BLVD STE 800
ATLANTA GA
30349-5596
US

V. Phone/Fax

Practice location:
  • Phone: 404-348-2750
  • Fax:
Mailing address:
  • Phone: 404-348-2750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HILLARY KOERNER
Title or Position: MANAGER
Credential:
Phone: 561-908-3200