Basic Information
| Provider Information | |||||||||
| NPI: | 1386626059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASSITY | ||||||||
| FirstName: | OSCAR | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | WATKINSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306776004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064754350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 EXCHANGE BLVD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306201759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005326151 | ||||||||
| FaxNumber: | 7063545769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 04/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 29152 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000405083A | 05 | GA | MEDICAID |