BRAIN RESTORATION CLINIC PLLC NPI 1871912667

NPI Information

  • NPI: 1871912667
  • Provider Name: BRAIN RESTORATION CLINIC, PLLC
  • Classification: Psychiatry & Neurology - 2084N0402X
  • Specialization: Neurology with Special Qualifications in Child Neurology
  • Entity Type: Organization
  • Address: 1040 EDGEWATER CORP PKWY
    SUITE 106
    INDIAN LAND, SC
    ZIP 29707
  • Phone: (704) 541-9117

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NPI Details

BRAIN RESTORATION CLINIC, PLLC is a neurology with special qualifications in child neurology psychiatry neurology in Indian Land, SC. The provider is a Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. BRAIN RESTORATION CLINIC, PLLC NPI is 1871912667. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1040 EDGEWATER CORP PKWY
SUITE 106
INDIAN LAND, SC
ZIP 29707-514
Phone: (704) 541-9117
Fax: (704) 541-9137

The provider's authorized official is Jean-ronel Corbier .
The authorized official title is Owner and has the following contact phone number (704) 541-9117.

The enumeration date for this NPI number is 4/9/2014 and was last updated on 8/5/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084N0402XPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology200601910NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1H26468MEDICARE UPINNORTH CAROLINA
25905648MEDICAIDNORTH CAROLINA

What is NPI?

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This page was last updated on: 11/21/2025

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