MEDICARE: BRIGHTENING GLANCE PSYCHIATRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1104789718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTENING GLANCE PSYCHIATRY

Provider Business Mailing Address
First Line	:	418 CREEKSTONE RDG
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-3740
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 CREEKSTONE RDG
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-3740
Country	:	US
Telephone Number	:	770-433-2821
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	GARY WEICHBRODT
Credential	:	MD
Telephone Number	:	770-433-2821

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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