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General NPI Number Information
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NPI Number | 1902799471
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Entity Type | Organization
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Legal Business Name | BRAIN TRAIN CENTERS EAST COBB LLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1000 JOHNSON FERRY RD STE 125
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City | MARIETTA
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State | GA
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Zip | 30068-2114
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Country | US
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Telephone | 470-423-1452
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Fax |
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Provider Business Mailing Address
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Address Line | 3124 N MEADOW CT
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City | MARIETTA
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State | GA
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Zip | 30062-5158
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Country | US
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Telephone | 470-423-1452
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JENNIFER DAVENPORT
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Credential |
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Telephone | 470-423-1452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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