MEDICARE: SARAH MARY PATTON LCSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ADC-003037-2014	FL
2	1041C0700X	Clinical Social Worker	6379	TN
3	1041C0700X	Clinical Social Worker	SW11679	FL
4	1041C0700X	Clinical Social Worker	CSW006258	GA

General Provider Information

NPI Number	:	1730635426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MARY PATTON LCSW

Provider Business Mailing Address
First Line	:	2450 ATLANTA HWY STE 1503
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-1277
Country	:	US
Telephone Number	:	678-722-1031
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 ATLANTA HWY STE 1503
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-1277
Country	:	US
Telephone Number	:	678-722-1031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	07/19/2019

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