Provider Demographics
NPI:1255123147
Name:BRIDGE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:BRIDGE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBUNOLUWA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-917-5484
Mailing Address - Street 1:164 AL JENNAH BLVD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3753
Mailing Address - Country:US
Mailing Address - Phone:770-678-0038
Mailing Address - Fax:770-678-0038
Practice Address - Street 1:324 E BROAD STREET
Practice Address - Street 2:SUITE 109B
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223
Practice Address - Country:US
Practice Address - Phone:770-678-0038
Practice Address - Fax:770-678-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty