Active NPI
Georgia Urology PA
- Urology Physician
- Fayetteville, GA
National Provider Identifier
1407194558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- Legal business name
- GEORGIA UROLOGY PA
- Practice address
- 1267 Highway 54 W
Suite 5200
Fayetteville, GA 30214-2114 - Phone
- (777) 046-0977
- NPI assigned
- Jan 24, 2013
- Last updated
- May 6, 2026
- Organization subpart
- Yes
- Parent organization
- GEORGIA UROLOGY PA
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 | NU | Primary |
Addresses
Primary practice location
1267 Highway 54 W
Suite 5200
Fayetteville, GA 30214-2114
Mailing address
1930 Brannan Rd
McDonough, GA 30253-4310
Phone (678) 284-4040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040422000123 | GA | Part B Supplier - Clinic/Group Practice | 8921094376 |
Receives reassigned benefits from 136 practitioners 18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fayetteville, GA; Gainesville, GA; Cumming, GA; Jasper, GA; Johns Creek, GA; Lawrenceville, GA; Lithonia, GA; Marietta, GA… |
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 Directory- Part of
- Ga Urology ASC Canton
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Urology Physician
- Lawrenceville, GA
- NPI 1326050485
-
- Urology Physician
- Riverdale, GA
- NPI 1447368626
-
- Pediatric Urology Physician
- Atlanta, GA
- NPI 1336243898
-
- Pediatric Urology Physician
- Fort Myers, FL
- NPI 1336174085
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358985600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1778025600000",
"number": "1407194558",
"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": "1267 HIGHWAY 54 W",
"address_2": "SUITE 5200",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302142114",
"telephone_number": "777-046-0977"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GEORGIA UROLOGY PA",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "GEORGIA UROLOGY PA",
"enumeration_date": "2013-01-24",
"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": "",
"desc": "Urology",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, 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.