Healthcare Provider Details

I. General information

NPI: 1194977561
Provider Name (Legal Business Name): OAKLAND SURGICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 LAWRENCE ST NE
MARIETTA GA
30060-1647
US

IV. Provider business mailing address

PO BOX 92
MARIETTA GA
30061-0092
US

V. Phone/Fax

Practice location:
  • Phone: 404-899-3800
  • Fax:
Mailing address:
  • Phone: 404-899-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN069889
License Number StateGA

VIII. Authorized Official

Name: DEBORAH SCHREER
Title or Position: OWNER
Credential: CRNFA
Phone: 404-899-3800