NPIMap

Organization Active NPI

Georgia Urology, PA

Doing business as GA Urology ASC Canton

  • Ambulatory Surgical Clinic/Center
  • Canton, GA
National Provider Identifier
1598412256
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
GEORGIA UROLOGY, PA
Doing business as
GA Urology ASC Canton
Practice address
100 Liberty Blvd Ste 230
Canton, GA 30114-2852
Phone
(770) 720-7246
NPI assigned
Mar 3, 2022
Last updated
May 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 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
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

100 Liberty Blvd Ste 230
Canton, GA 30114-2852

Mailing address

1930 Brannan Rd
McDonough, GA 30253-4310

Other names 1

  • GA Urology ASC Canton Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220411000007 GA Part B Supplier - Ambulatory Surgical Center 8921094376 Practice locations: Canton, GA

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Georgia Urology PA Dba Georgia Urology ASC CantonCCN 11C0001562
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

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

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

NPI Registry JSON

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

{
    "created_epoch": "1646265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1598412256",
    "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": "100 LIBERTY BLVD STE 230",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142852",
            "telephone_number": "770-720-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA UROLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-03",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "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": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GA Urology ASC Canton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.