Healthcare Provider Details

I. General information

NPI: 1124653456
Provider Name (Legal Business Name): OASIS SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10175 DALLAS ACWORTH HWY STE 103-14
DALLAS GA
30132-9300
US

IV. Provider business mailing address

10175 DALLAS ACWORTH HWY STE 103-14
DALLAS GA
30132-9300
US

V. Phone/Fax

Practice location:
  • Phone: 678-481-1647
  • 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 Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACKIE LYNN SCHUMAKER
Title or Position: OWNER
Credential: CSFA
Phone: 678-758-8164