MEDICARE: OASIS SURGICAL ASSISTANTS GROUP RESOURCES L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1902466816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS SURGICAL ASSISTANTS GROUP RESOURCES L.L.C.

Provider Business Mailing Address
First Line	:	1720 MARS HILL RD NW STE 8-175
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-7127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 MARS HILL RD NW STE 8-175
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-7127
Country	:	US
Telephone Number	:	470-336-8190
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HERB COUSIN
Credential	:
Telephone Number	:	470-336-8190

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/13/2019

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