NPIMap

Organization Active NPI

Georgia Urology PA

  • Urology Physician
  • Douglasville, GA
National Provider Identifier
1508081795
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
GEORGIA UROLOGY PA
Practice address
4645 Timber Ridge Dr Ste 120
Douglasville, GA 30135-7542
Phone
(770) 942-2478
Fax
(678) 631-4986
NPI assigned
Apr 15, 2007
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
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

4645 Timber Ridge Dr Ste 120
Douglasville, GA 30135-7542

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
11D0980072OtherGACLIA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2100885Georgia Urology4645 Timber Ridge Drive Suite 120, Douglasville, GA 30135Provider-performed microscopyAug 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Georgia Urology53 organizations share this tax ID, including this one
Part of
Georgia Urology

Organizations with this tax ID in the same state 24

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

View all 24

Locations

6001 Professional Pkwy
Ste 1030
Douglasville, GA 30134
Phone (404) 274-7335

NPI Registry JSON

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

{
    "created_epoch": "1176595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1508081795",
    "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": "4645 TIMBER RIDGE DR STE 120",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301357542",
            "telephone_number": "770-942-2478",
            "fax_number": "678-631-4986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA UROLOGY PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA UROLOGY PA",
        "enumeration_date": "2007-04-15",
        "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "11D0980072",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, 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 Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.