1326678228 NPI number — OASIS AMBULATORY SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326678228 NPI number — OASIS AMBULATORY SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OASIS AMBULATORY SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326678228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 PHOENIX BLVD STE 128-7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEGE PARK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30349-5593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-655-6247
Provider Business Mailing Address Fax Number:
404-891-7089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 PHOENIX BLVD STE 128-7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30349-5593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-655-6247
Provider Business Practice Location Address Fax Number:
404-891-7089
Provider Enumeration Date:
01/20/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRACKETT
Authorized Official First Name:
NATASHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
404-655-6247

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)