Organization
GEORGIA UROLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN FELLNER (CEO)
(678) 205-8360
Entity
Organization
Contact information
Practice address
33 UPPER RIVERDALE RD SW, SUITE 105, RIVERDALE, GA 30274-2626
(770) 991-0020
(770) 994-9729
Mailing address
1930 BRANNAN RD, MCDONOUGH, GA 30253-4310
(678) 284-4040
(678) 284-4076
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP1552
GROUP NUMBER
GA
Enumeration date
07/20/2006
Last updated
05/06/2026
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