Southern Grace Psychiatry LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SOUTHERN GRACE PSYCHIATRY LLC

Practice address

1775 Parker Rd SE Ste 210
Conyers, GA 30094-6654

Phone

(754) 364-7252

NPI assigned

Oct 20, 2026

Last updated

Oct 20, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Danielle Evette Street, PMHNP-BCNPI 1043877947

Title

Owner

Phone

(754) 264-7252

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Danielle Evette Street, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Conyers, GA
  • NPI 1043877947
  Authorized official Same address or phone

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

{
    "created_epoch": "1792454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792454400000",
    "number": "1760389100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 PARKER RD SE STE 210",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300946654",
            "telephone_number": "754-364-7252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 PARKER RD SE STE 210",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300946654",
            "telephone_number": "754-364-7252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN GRACE PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-20",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "status": "A",
        "authorized_official_last_name": "STREET",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "EVETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "754-264-7252",
        "authorized_official_credential": "PMHNP-BC"
    },
    "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": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Conyers, GA
• Providers in Conyers, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.