Healthcare Provider Details

I. General information

NPI: 1336044437
Provider Name (Legal Business Name): MARIETTA BRAIN HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 WASHINGTON AVE NE
MARIETTA GA
30060-1959
US

IV. Provider business mailing address

216 WASHINGTON AVE NE
MARIETTA GA
30060-1959
US

V. Phone/Fax

Practice location:
  • Phone: 770-790-3522
  • Fax:
Mailing address:
  • Phone: 770-790-3522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERRI ABRAHAM
Title or Position: PARTNER
Credential: LPC
Phone: 770-591-7518