Provider Demographics
NPI:1386626059
Name:CASSITY, OSCAR T (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:T
Last Name:CASSITY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-6004
Mailing Address - Country:US
Mailing Address - Phone:706-475-4350
Mailing Address - Fax:
Practice Address - Street 1:340 EXCHANGE BLVD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-1759
Practice Address - Country:US
Practice Address - Phone:800-532-6151
Practice Address - Fax:706-354-5769
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29152207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000405083AMedicaid
D45031Medicare UPIN
GA01BDCQTMedicare ID - Type Unspecified