MEDICARE: BRIDGEPOINT CLINIC

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	:	1396464483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEPOINT CLINIC

Provider Business Mailing Address
First Line	:	4125 ATLANTA RD SE STE 120
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6526
Country	:	US
Telephone Number	:	770-858-5377
Fax Number	:	770-874-3310

Provider Business Practice Location Address
First Line	:	4125 ATLANTA RD SE STE 120
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6526
Country	:	US
Telephone Number	:	770-858-5377
Fax Number	:	770-874-3310

Authorized Official
Title or Position	:	OWNER
Name	:	ARUN KANTAMNENI
Credential	:	MD
Telephone Number	:	770-858-5377

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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Directions to “BRIDGEPOINT CLINIC ” Practice Location

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