NPIMap

Organization Active NPI

Georgia Urology, PA

  • Ambulatory Surgical Clinic/Center
  • Braselton, GA
National Provider Identifier
1861222119
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
Practice address
1223 Friendship Rd.
BLDG. 400, Suite 110
Braselton, GA 30517
Phone
(770) 963-2451
NPI assigned
Aug 2, 2024
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 NU Primary

Addresses

Primary practice location

1223 Friendship Rd.
BLDG. 400, Suite 110
Braselton, GA 30517

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 IDStateProvider typePAC IDDetails
O20260203001066 GA Part B Supplier - Ambulatory Surgical Center 8921094376 Practice locations: Braselton, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861222119. Details of each certification follow.

Ambulatory surgical center certification: CCN 11C0001592

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 Ambulatory Surgery Center Braselton
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jun 26, 2025
Last certification
May 29, 2025
Facility address
1223 Friendship Road Building 400 Suite 110
Braselton, GA 30517

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

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

Organizations with this tax ID in the same state 21

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

View all 21

Locations (25 of 30)

11975 Morris Rd
Ste 330
Alpharetta, GA 30005
Phone (770) 442-1200

3005 Royal Blvd S
Ste 120
Alpharetta, GA 30022
Phone (770) 777-9400

3400 Old Milton Pkwy
Ste 185
Alpharetta, GA 30005
Phone (770) 772-4427

35 Collier Rd NW
Ste 245
Atlanta, GA 30309
Phone (678) 205-8211

3890 Redwine Rd SW
Ste 112
Atlanta, GA 30331
Phone (404) 352-3300

95 Collier Rd NW
Ste 6025
Atlanta, GA 30309
Phone (404) 352-9260

1700 Hospital South Dr
Ste 201
Austell, GA 30106
Phone (770) 948-7228

1223 Friendship Rd
Bldg 400
Braselton, GA 30517
Phone (678) 205-8387

4445 S Lee St
Ste 300
Buford, GA 30518
Phone (770) 219-8765

100 Liberty Blvd
Ste 230
Canton, GA 30114
Phone (678) 593-1043

320 Hospital Rd
Ste 101
Canton, GA 30114
Phone (770) 720-7246

9 Medical Dr NE
Ste A
Cartersville, GA 30121
Phone (770) 607-1893

1301 Sigman Rd NE
Ste 250B
Conyers, GA 30012
Phone (770) 760-9900

4142 Mill St NE
Covington, GA 30014
Phone (770) 787-3550

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

3790 Pleasant Hill Rd
Ste 150
Duluth, GA 30096
Phone (678) 414-0400

1136 Cleveland Ave
Ste 505
East Point, GA 30344
Phone (404) 766-7151

433 Highland Pkwy
Ste 102
Ellijay, GA 30540
Phone (706) 222-4255

1260 Highway 54 W
Ste 204
Fayetteville, GA 30214
Phone (770) 460-9777

220 J L White Dr
Ste 160
Jasper, GA 30143
Phone (706) 692-4384

500 Medical Center Blvd
Ste 220
Lawrenceville, GA 30046
Phone (770) 963-2451

720 Old Snellville Hwy
Ste 100
Lawrenceville, GA 30044
Phone (770) 963-2451

5910 Hillandale Dr
Ste 201
Lithonia, GA 30058
Phone (770) 760-8484

790 Church St NE
Ste 430
Marietta, GA 30060
Phone (770) 429-9100

2161 W Spring St
Ste C
Monroe, GA 30655
Phone (678) 635-8130

Practitioners & affiliated clinicians

Practitioners 138

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.

View all 138

NPI Registry JSON

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

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1861222119",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 FRIENDSHIP RD.",
            "address_2": "BLDG. 400, SUITE 110",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "30517",
            "telephone_number": "770-963-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA UROLOGY, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA UROLOGY, PA",
        "enumeration_date": "2024-08-02",
        "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": []
}

Other providers in Braselton, GA

Sources for this page

Verify at the official NPI Registry.