Active NPI
Georgia Urology, PA
- Urology Physician
- Lawrenceville, GA
National Provider Identifier
1245875236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- Legal business name
- GEORGIA UROLOGY, PA
- Practice address
- 631 Professional Dr Ste 490
Lawrenceville, GA 30046-3370 - Phone
- (770) 995-0424
- NPI assigned
- Nov 13, 2019
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | Primary |
Addresses
Primary practice location
631 Professional Dr Ste 490
Lawrenceville, GA 30046-3370
Mailing address
1930 Brannan Rd
McDonough, GA 30253-4310
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
Other NPIs on the same Medicare enrollment 18
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Ambulatory Surgical Clinic/Center
- Cumming, GA
- NPI 1780199356
O20040422000123
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Acute Care Nurse Practitioner
- Decatur, GA
- NPI 1053067637
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573603200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1778025600000",
"number": "1245875236",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "631 PROFESSIONAL DR STE 490",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300463370",
"telephone_number": "770-995-0424"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GEORGIA UROLOGY, PA",
"organizational_subpart": "NO",
"enumeration_date": "2019-11-13",
"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": "208800000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Urology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.