Provider Demographics
NPI:1124552088
Name:THE BRIDGE OF GEORGIA SCHOOL, INC
Entity Type:Organization
Organization Name:THE BRIDGE OF GEORGIA SCHOOL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMILA
Authorized Official - Middle Name:EMBRY
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-406-6111
Mailing Address - Street 1:109 BLAINE ST
Mailing Address - Street 2:PO BOX 542
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2403
Mailing Address - Country:US
Mailing Address - Phone:770-406-6111
Mailing Address - Fax:678-635-8709
Practice Address - Street 1:109 BLAINE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2403
Practice Address - Country:US
Practice Address - Phone:770-406-6111
Practice Address - Fax:678-635-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency