Healthcare Provider Details

I. General information

NPI: 1134622533
Provider Name (Legal Business Name): OASIS SURGICAL ASSISTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2537 CEDARCREST RD STE 305-14
ACWORTH GA
30101-8900
US

IV. Provider business mailing address

2537 CEDARCREST RD STE 305-14
ACWORTH GA
30101-8900
US

V. Phone/Fax

Practice location:
  • Phone: 470-336-8190
  • Fax: 770-336-6620
Mailing address:
  • Phone: 678-758-8164
  • Fax: 770-336-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MORGAN HOLNAIDER
Title or Position: CERTIFIED SURGICAL ASSISTANT
Credential: CSA
Phone: 470-336-8190