MEDICARE: GRANTING GRACE PSYCHIATRY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1174473011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANTING GRACE PSYCHIATRY, LLC

Provider Business Mailing Address
First Line	:	998 HIGHWAY 19 41 UNIT 1431
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-3662
Country	:	US
Telephone Number	:	470-385-2690
Fax Number	:	470-275-0696

Provider Business Practice Location Address
First Line	:	998 HIGHWAY 19 41 UNIT 1431
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-3662
Country	:	US
Telephone Number	:	470-385-2690
Fax Number	:	470-275-0696

Authorized Official
Title or Position	:	OWNER
Name	:	JAZMINE CROWE
Credential	:	NP
Telephone Number	:	470-385-2690

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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