Healthcare Provider Details

I. General information

NPI: 1982436283
Provider Name (Legal Business Name): SARA FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 GREENBRIAR CIR
DECATUR GA
30033-4421
US

IV. Provider business mailing address

2068 MOUNTAIN CREEK RD
STONE MOUNTAIN GA
30087-1030
US

V. Phone/Fax

Practice location:
  • Phone: 727-667-8043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004557
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: