Healthcare Provider Details

I. General information

NPI: 1942098231
Provider Name (Legal Business Name): BRAINTRUST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 BEST RD. SUITE 177
COLLEGE PARK GA
30337
US

IV. Provider business mailing address

3133 MAPLE DR NE STE 240
ATLANTA GA
30305-2509
US

V. Phone/Fax

Practice location:
  • Phone: 404-967-4164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM CARMONA
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 404-967-4164