Healthcare Provider Details

I. General information

NPI: 1023141918
Provider Name (Legal Business Name): THE BRIDGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 JOHNSON RD NW
ATLANTA GA
30318-4017
US

IV. Provider business mailing address

1559 JOHNSON RD NW
ATLANTA GA
30318-4017
US

V. Phone/Fax

Practice location:
  • Phone: 404-792-0070
  • Fax: 404-794-0444
Mailing address:
  • Phone: 404-792-0070
  • Fax: 404-794-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberCCI-10054
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCCI-10054
License Number StateGA

VIII. Authorized Official

Name: MR. THOMAS AUSTIN WEBB
Title or Position: CFO
Credential:
Phone: 404-446-1531