Provider Demographics
NPI:1124653456
Name:OASIS SURGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:OASIS SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHUMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:678-758-8164
Mailing Address - Street 1:170 BLACKBERRY RUN DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-1174
Mailing Address - Country:US
Mailing Address - Phone:678-758-8164
Mailing Address - Fax:
Practice Address - Street 1:800 KENNESAW AVE NW STE 130
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1052
Practice Address - Country:US
Practice Address - Phone:678-556-5138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty