Healthcare Provider Details

I. General information

NPI: 1174431167
Provider Name (Legal Business Name): BROOKSTONE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 EXECUTIVE CENTER DR STE A
AUGUSTA GA
30907-2326
US

IV. Provider business mailing address

117 HUGH RD
LEESBURG GA
31763-5202
US

V. Phone/Fax

Practice location:
  • Phone: 762-257-5882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW CORLEY
Title or Position: MANAGER
Credential:
Phone: 229-496-6963