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
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

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 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

11459 Johns Creek Pkwy
Ste 170
Johns Creek, GA 30097
Phone (678) 417-0400

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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

  • 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.