Brain Restoration Clinic, PLLC

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

License

200601910 Issued in NC

Legal business name

BRAIN RESTORATION CLINIC, PLLC

Practice address

1040 Edgewater Corp Pkwy
Suite 106
Indian Land, SC 29707-4514

Phone

(704) 541-9117

Fax

(704) 541-9137

NPI assigned

Apr 9, 2014

Last updated

Aug 5, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jean-Ronel Corbier, M.D.NPI 1225193105

Title

Owner

Phone

(704) 541-9117

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jean-Ronel Corbier, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Indian Land, SC
  • NPI 1225193105
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438732800000",
    "number": "1871912667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 EDGEWATER CORP PKWY",
            "address_2": "SUITE 106",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297074514",
            "telephone_number": "704-541-9117",
            "fax_number": "704-541-9137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 EDGEWATER CORP PKWY",
            "address_2": "SUITE 106",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297074514",
            "telephone_number": "704-541-9117",
            "fax_number": "704-541-9137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAIN RESTORATION CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-09",
        "last_updated": "2015-08-05",
        "status": "A",
        "authorized_official_last_name": "CORBIER",
        "authorized_official_first_name": "JEAN-RONEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-541-9117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "NC",
            "license": "200601910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905648",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Birth Center at Well Body, LLC
• Blair Harris Bones, PT
• Daniel Scott Boney, PHARMD
• Nam Gin Paul Bowman
• Jessica Bradburn, DC
• Renee E Brassell, RN
• Kacie A Breault, OD
• Kerry Patterson Briones, MD
• Kimberly Hrobak Bumgardner, OTR/L
• George Archibald Butler, MD

• Neurology with Special Qualifications in Child Neurology Physician in Indian Land, SC
• Providers in Indian Land, SC by specialty
• Neurology with Special Qualifications in Child Neurology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.