Organization
PROVENANCE PSYCHIATRIC SERVICES LLC
Active
Organization
PROVENANCE PSYCHIATRIC SERVICES LLC
Active
Other names
Provenance Psychiatry
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KENT JOHNSON APRN (OWNER)
(610) 453-1548
Entity
Organization
Contact information
Practice address
643 RAY LEWIS RD, BLAIRSVILLE, GA 30512-1439
(706) 970-1948
(877) 930-7732
Mailing address
643 RAY LEWIS RD, BLAIRSVILLE, GA 30512-1439
(706) 970-1948
(877) 930-7732
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
—
—
Other
Enumeration date
06/27/2023
Last updated
03/19/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up