MEDICARE: DIVINE 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	:	1346118106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	3060 MERCER UNIVERSITY DR STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-4135
Country	:	US
Telephone Number	:	404-491-1662
Fax Number	:	678-394-0505

Provider Business Practice Location Address
First Line	:	800 OLD ROSWELL LAKES PKWY STE 360
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-1692
Country	:	US
Telephone Number	:	404-491-1662
Fax Number	:	678-394-0505

Authorized Official
Title or Position	:	AUTHORIZED INDIVIDUAL
Name	:	ANDREW PIERCE
Credential	:
Telephone Number	:	307-683-0983

Provider Enumeration Date	:	10/24/2025
Last Update Date	:	04/02/2026

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Directions to “DIVINE PSYCHIATRY LLC ” Practice Location

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