Organization Active NPI

Divine Psychiatry LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Roswell, GA
National Provider Identifier
1346118106
Registry record updated Apr 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
DIVINE PSYCHIATRY LLC
Practice address
800 Old Roswell Lakes Pkwy Ste 360
Roswell, GA 30076-1692
Phone
(404) 491-1662
Fax
(678) 394-0505
NPI assigned
Oct 24, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrew Pierce
Title
Authorized Individual
Phone
(307) 683-0983

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

800 Old Roswell Lakes Pkwy Ste 360
Roswell, GA 30076-1692

Mailing address

3060 Mercer University Dr Ste 110
Atlanta, GA 30341-4135
Phone (404) 491-1662

Other practice location 1

1309 Coffeen Ave Ste 1200
Sheridan, WY 82801-5777
Phone (678) 837-6104

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260317002799 GA Part B Supplier - Clinic/Group Practice 5496239584 Receives reassigned benefits from 1 practitioner
Practice locations: Roswell, GA

National Provider Directory

National Provider Directory

Locations

800 Old Roswell Lakes Pkwy
Ste 360
Roswell, GA 30076
Phone (404) 491-1662

700 Old Roswell Lakes Pkwy
Ste 300
Roswell, GA 30076
Phone (404) 218-9213

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1761264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775088000000",
    "number": "1346118106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 MERCER UNIVERSITY DR STE 110",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414135",
            "telephone_number": "404-491-1662",
            "fax_number": "678-394-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 OLD ROSWELL LAKES PKWY STE 360",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300761692",
            "telephone_number": "404-491-1662",
            "fax_number": "678-394-0505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1309 Coffeen Ave Ste 1200",
            "address_purpose": "LOCATION",
            "city": "Sheridan",
            "state": "WY",
            "postal_code": "828015777",
            "country_code": "US",
            "telephone_number": "678-837-6104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DIVINE PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-24",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "AUTHORIZED INDIVIDUAL",
        "authorized_official_telephone_number": "307-683-0983"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.