Georgia Urology Northeast LLC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

GEORGIA UROLOGY NORTHEAST LLC

Practice address

1223 Friendship Rd.
BLDG. 400, Suite 100
Braselton, GA 30517

Phone

(678) 205-8387

NPI assigned

Dec 17, 2024

Last updated

May 6, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

GEORGIA UROLOGY, PAAs reported in NPPES

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) 284-4040

Specialties & licenses 1

Addresses

Part of

Ga Urology ASC Canton

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

{
    "created_epoch": "1734393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1205643897",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 FRIENDSHIP RD.",
            "address_2": "BLDG. 400, SUITE 100",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "30517",
            "telephone_number": "678-205-8387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA UROLOGY NORTHEAST LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA UROLOGY, PA",
        "enumeration_date": "2024-12-17",
        "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": "678-284-4040"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nima Ghasemzadeh, MD
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• Urology Physician in Braselton, GA
• Providers in Braselton, GA by specialty
• Urology Physician in Georgia

• 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.