Provenance Psychiatric Services LLC

Primary specialty

Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X

Legal business name

PROVENANCE PSYCHIATRIC SERVICES LLC

Doing business as

Provenance Psychiatry

Practice address

643 Ray Lewis Rd
Blairsville, GA 30512-1439

Phone

(706) 970-1948

Fax

(877) 930-7732

NPI assigned

Jun 27, 2023

Organization subpart

No

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

Authorized official

Name

Brian Kent Johnson, APRNNPI 1669177846

Title

Owner

Phone

(610) 453-1548

Specialties & licenses 1

Addresses

Other names 1

• Provenance Psychiatry Doing business as

Locations

Practitioners 2

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

• Brian Kent Johnson, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Murphy, NC
  • NPI 1669177846

  Single Specialty

  NPD Authorized official
• Dusty Lynn Johnson, CRNA

  • Certified Registered Nurse Anesthetist
  • Blairsville, GA
  • NPI 1265494785
  NPD

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

{
    "created_epoch": "1687824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1932885530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "643 RAY LEWIS RD",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305121439",
            "telephone_number": "706-970-1948",
            "fax_number": "877-930-7732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "643 RAY LEWIS RD",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305121439",
            "telephone_number": "706-970-1948",
            "fax_number": "877-930-7732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENANCE PSYCHIATRIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-27",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-453-1548",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provenance Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Johnny C Pitts, PA-C
• Sandra Danette Poppell, DO
• James Portwood, PA-C
• Edwin Currier Pound III, MD
• Premier Eye Care Assoc. PC
• April Prunier, LPN
• Richard W Putnam, DDS
• Quality Respi-Care Inc
• Debora Rose Quigley, MD
• Michael Ray

• Psychiatric/Mental Health Clinical Nurse Specialist in Blairsville, GA
• Providers in Blairsville, GA by specialty
• Psychiatric/Mental Health Clinical Nurse Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; 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.