Provider Demographics
NPI: | 1710626155 |
---|---|
Name: | OASIS MENTAL HEALTH & NEUROPSYCHIATRY CLINIC |
Entity Type: | Organization |
Organization Name: | OASIS MENTAL HEALTH & NEUROPSYCHIATRY CLINIC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ZEBULON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FOREMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | NP |
Authorized Official - Phone: | 678-401-6856 |
Mailing Address - Street 1: | 8309 OFFICE PARK DR |
Mailing Address - Street 2: | |
Mailing Address - City: | DOUGLASVILLE |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30134-6935 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 678-401-6856 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3040 HIGHLANDS PKWY SE STE F |
Practice Address - Street 2: | |
Practice Address - City: | SMYRNA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30082-5178 |
Practice Address - Country: | US |
Practice Address - Phone: | 678-401-6856 |
Practice Address - Fax: | 678-623-3307 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-06-02 |
Last Update Date: | 2023-02-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |