Organization
BRAIN WAVES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA BRADELY (AUTHORIZED OFFICIAL)
(601) 575-3392
Entity
Organization
Contact information
Practice address
587 HIGHWAY 51 STE L, RIDGELAND, MS 39157-2573
(601) 575-3392
Mailing address
587 HIGHWAY 51 STE L, RIDGELAND, MS 39157-2573
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/27/2022
Last updated
07/27/2022
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