NPIMap

Organization Active NPI

Georgia Urology PA

  • Pediatric Urology Physician
  • Atlanta, GA
National Provider Identifier
1174749055
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
Legal business name
GEORGIA UROLOGY PA
Practice address
5445 Meridian Marks Rd NE
Suite 420
Atlanta, GA 30342-4763
Phone
(404) 252-5206
Fax
(404) 252-1268
NPI assigned
Apr 18, 2007
Last updated
May 6, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
GEORGIA UROLOGY PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dan Fellner
Title
Ceo
Phone
(678) 205-8360

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology Physician 2088P0231X NU Primary

Addresses

Primary practice location

5445 Meridian Marks Rd NE
Suite 420
Atlanta, GA 30342-4763

Mailing address

1930 Brannan Rd
McDonough, GA 30253-4310
Phone (678) 284-4040

Other identifiers 1

IdentifierTypeStateIssuer
11D0694347OtherGACLIA

National Provider Directory

National Provider Directory
Tax ID family
Ga Urology ASC Canton53 organizations share this tax ID, including this one
Part of
Ga Urology ASC Canton

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1174749055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 BRANNAN RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302534310",
            "telephone_number": "678-284-4040",
            "fax_number": "678-284-4076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5445 MERIDIAN MARKS RD NE",
            "address_2": "SUITE 420",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424763",
            "telephone_number": "404-252-5206",
            "fax_number": "404-252-1268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA UROLOGY PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA UROLOGY PA",
        "enumeration_date": "2007-04-18",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A",
        "authorized_official_last_name": "FELLNER",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-205-8360"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "11D0694347",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.