Healthcare Provider Details

I. General information

NPI: 1821638149
Provider Name (Legal Business Name): OASIS MEDICAL CENTER OF GEORGIA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MERCHANTS SQ
DALLAS GA
30132-5029
US

IV. Provider business mailing address

280 MERCHANTS SQ
DALLAS GA
30132-5029
US

V. Phone/Fax

Practice location:
  • Phone: 678-398-9758
  • Fax: 404-692-5438
Mailing address:
  • Phone: 678-398-9758
  • Fax: 404-692-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPHINE U ANUFORO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 404-697-1445