Provider Demographics
NPI:1336561133
Name:OASIS SURGICAL ASSISTANTS L.L.C.
Entity type:Organization
Organization Name:OASIS SURGICAL ASSISTANTS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:COUSIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CSA
Authorized Official - Phone:770-875-1243
Mailing Address - Street 1:6110 CEDARCREST RD NW
Mailing Address - Street 2:SUITE 350-184
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-9539
Mailing Address - Country:US
Mailing Address - Phone:770-875-1243
Mailing Address - Fax:404-464-0781
Practice Address - Street 1:6110 CEDARCREST RD NW
Practice Address - Street 2:SUITE 350-184
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9539
Practice Address - Country:US
Practice Address - Phone:770-875-1243
Practice Address - Fax:404-464-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4019363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty