Provenance Psychiatry

LBN: Provenance Psychiatric Services Llc
Provenance Psychiatry is an health care organization with primary practice located at 112 Professional Rd Ste 3 , Blue Ridge GA 30513-6205. The organization recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as the primary health care specialty. Provenance Psychiatric Services Llc can be contacted via phone (706) 970-1948, or through Johnson, Brian via phone (706) 970-1948.

Contact Information

Primary practice address
112 Professional Rd Ste 3 Blue Ridge GA 30513-6205
Phone: (706) 970-1948
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Johnson, Brian
Phone: (706) 970-1948

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 364SP0808X

Profile Details

NPI number 1932885530
LBN Legal business name Provenance Psychiatric Services Llc
DBA Doing business as Provenance Psychiatry
Authorized official Johnson, Brian
Entity Organization
Organization subpart 1 No
Enumeration date Jun 27th, 2023
Last updated Sep 7th, 2023 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Popular Providers