Healthcare Provider Details

I. General information

NPI: 1346736030
Provider Name (Legal Business Name): OASIS SURGICAL BILLING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENNESAW AVE NW
MARIETTA GA
30060-1051
US

IV. Provider business mailing address

800 KENNESAW AVE NW
MARIETTA GA
30060-1051
US

V. Phone/Fax

Practice location:
  • Phone: 770-687-9068
  • Fax:
Mailing address:
  • Phone: 770-687-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name: KELSEY CRATER
Title or Position: CEO
Credential: CST
Phone: 770-687-9068