=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184571416
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH BREEDEN LYNN LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2026
-----------------------------------------------------
Last Update Date | 03/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1539 OLD VALDOSTA RD
-----------------------------------------------------
City | RAY CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31645-7132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-422-3661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1262 SARAHS LANDING DR
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32221-5207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-379-4181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | MSW011961
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------