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PROVENANCE PSYCHIATRIC SERVICES LLC
NPI 1932885530
Clinical Nurse Specialist - Psychiatric/Mental Health in Blairsville, GA

Active since June 27, 2023
643 RAY LEWIS RD, BLAIRSVILLE, GA 30512(706) 970-1948(877) 930-7732 Get Directions Write a Review

NPPES record last updated: March 19, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 19, 2025, Mar 13, 2025, Sep 7, 2023 (3 updates tracked since 2023).

About Provenance Psychiatric Services Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVENANCE PSYCHIATRIC SERVICES LLC (NPI 1932885530), doing business as Provenance Psychiatry, is a healthcare organization registered as a psychiatric/mental health in Blairsville, Georgia and active in the NPI registry since June 2023. The organization lists Brian Kent Johnson, Owner, as its authorized official.

NPPES Registry Identity

NPI1932885530
Entity TypeOrganization
Primary Taxonomy364SP0808X
Legal Business NamePROVENANCE PSYCHIATRIC SERVICES LLC
Location Address643 RAY LEWIS RDBlairsville, GA 30512-1439
Mailing Address643 Ray Lewis RdBlairsville, GA 30512-1439 · (706) 970-1948 · Fax (877) 930-7732
Phone(706) 970-1948
Fax(877) 930-7732
Organization SubpartNo
Authorized OfficialBrian Kent JohnsonOwner · (610) 453-1548
Enumeration DateJune 27, 2023
Last NPPES UpdateMarch 19, 20253 updates tracked since enumeration
NPPES CertifiedMarch 19, 2025
✔ NPI 1932885530 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinical Nurse Specialist · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code364SP0808X
643 RAY LEWIS RD, Blairsville, GA 30512
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Other Names 1

Doing Business AsProvenance Psychiatry

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Provenance Psychiatric Services LLC's NPI number?

The NPI number for Provenance Psychiatric Services LLC is 1932885530. It was assigned to this organization in the NPPES registry on June 27, 2023. The provider is doing business as Provenance Psychiatry.

Where is Provenance Psychiatric Services LLC located?

Provenance Psychiatric Services LLC is located at 643 Ray Lewis Rd, Blairsville, GA 30512. The listed phone number is (706) 970-1948.

What is Provenance Psychiatric Services LLC's specialty?

The primary specialty registered for this NPI is Clinical Nurse Specialist, specializing in Psychiatric/Mental Health, with taxonomy code 364SP0808X.

When was this NPI record last updated?

The NPPES record for Provenance Psychiatric Services LLC was last updated on March 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.