Healthcare Provider Details

I. General information

NPI: 1508667940
Provider Name (Legal Business Name): COMPLETE BRAIN TESTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E CROSSVILLE RD STE 101
ROSWELL GA
30075-3058
US

IV. Provider business mailing address

425 E CROSSVILLE RD STE 101
ROSWELL GA
30075-3058
US

V. Phone/Fax

Practice location:
  • Phone: 678-214-8547
  • Fax:
Mailing address:
  • Phone: 678-214-8547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DR. MICHAEL DUCKETT
Title or Position: OWNER CEO
Credential: DO
Phone: 404-403-5689