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General NPI Number Information
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NPI Number | 1356860944
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Entity Type | Organization
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Legal Business Name | BRIGHTER BRAINS, LLC
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 124 SAVANNAH AVE STE 1C
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City | STATESBORO
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State | GA
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Zip | 30458-7149
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Country | US
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Telephone | 912-225-3760
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Fax | 912-225-3770
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Provider Business Mailing Address
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Address Line | PO BOX 2872
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City | STATESBORO
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State | GA
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Zip | 30459-2872
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Country | US
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Telephone | 912-481-2652
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Fax | 912-225-3770
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Authorized Official
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Title or Position | CEO, CLINICAL DIRECTOR
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Name | DR. JOY WELCKER
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Credential | PHD
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Telephone | 912-481-2652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 9526
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License Number State | GA
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