Healthcare Provider Details

I. General information

NPI: 1629995436
Provider Name (Legal Business Name): BRAIN BRIDGE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 W PEACHTREE ST NW
ATLANTA GA
30309-2917
US

IV. Provider business mailing address

1349 W PEACHTREE ST NW
ATLANTA GA
30309-2917
US

V. Phone/Fax

Practice location:
  • Phone: 407-850-8417
  • Fax: 943-236-2488
Mailing address:
  • Phone: 407-850-8417
  • Fax: 943-236-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KEESHA TAMARA MARIA HAMILTON-FOWLER
Title or Position: PMHNP
Credential: APRN
Phone: 407-850-8417