# BRAIN WAVES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508592023
- **Authorized official:** BARBARA BRADELY (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (601) 575-3392

## Contact information

- **Practice address:** 587 HIGHWAY 51 STE L, RIDGELAND, MS 39157-2573
- **Practice address phone:** (601) 575-3392
- **Mailing address:** 587 HIGHWAY 51 STE L, RIDGELAND, MS 39157-2573

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/27/2022
- **Last updated:** 07/27/2022