NPIMap

Organization Active NPI

Georgia Urology ASC Cumming

  • Ambulatory Surgical Clinic/Center
  • Cumming, GA
National Provider Identifier
1780199356
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 ASC CUMMING
Practice address
4150 Deputy Bill Cantrell Memorial Road
Suite 140a
Cumming, GA 30040
Phone
(770) 889-9737
NPI assigned
Dec 5, 2017
Last updated
May 5, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
GEORGIA UROLOGY PAAs reported in NPPES

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 Primary

Addresses

Primary practice location

4150 Deputy Bill Cantrell Memorial Road
Suite 140a
Cumming, GA 30040

Mailing address

1930 Brannan Rd
McDonough, GA 30253-4310

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…
O20090318000546 GA Part B Supplier - Ambulatory Surgical Center 8921094376 Receives reassigned benefits from 1 practitioner
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Conyers, GA; Cumming, GA; Decatur, GA; Fayetteville, GA; Lawrenceville, GA; Smyrna, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780199356. Details of each certification follow.

Ambulatory surgical center certification: CCN 11C0001506

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GEORGIA UROLOGY,PA CUMMING AMBULATORY SURGERY CTR
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Apr 12, 2019
Last certification
Apr 12, 2019
Ownership / control type
Proprietary
Facility address
4150 Deputy Bill Cantrell Memorial Road, Ste 140 a
Cumming, GA 30040

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Georgia Urology Dba Cumming Ambulatory Surgery CenterCCN 11C0001596
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Georgia Urology PA53 organizations share this tax ID, including this one
Part of
Georgia Urology PA

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1780199356",
    "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": "4150 DEPUTY BILL CANTRELL MEMORIAL ROAD",
            "address_2": "SUITE 140A",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "30040",
            "telephone_number": "770-889-9737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA UROLOGY ASC CUMMING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA UROLOGY PA",
        "enumeration_date": "2017-12-05",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.