MEDICARE: BREANNA LYNCH

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	163WH0200X	Home Health Registered Nurse	PHCP01115	GA

General Provider Information

NPI Number	:	1992493068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA LYNCH

Provider Business Mailing Address
First Line	:	531 BARBARA CT
Second Line	:
City	:	FORSYTH
State	:	GA
Zip	:	31029-7377
Country	:	US
Telephone Number	:	470-513-8648
Fax Number	:

Provider Business Practice Location Address
First Line	:	3754 HIRAM ACWORTH HWY STE D
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-3275
Country	:	US
Telephone Number	:	678-401-8325
Fax Number	:

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

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	04/26/2023

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