Organization
GEORGIA UROLOGY PA
Active
Organization
GEORGIA UROLOGY PA
Active
Parent organization
GEORGIA UROLOGY PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA UROLOGY PA
Authorized official
DAN FELLNER (CEO)
(678) 205-8360
Entity
Organization
Contact information
Practice address
1275 HIGHWAY 54 W, SUITE 205, FAYETTEVILLE, GA 30214-4549
(770) 716-9656
(770) 716-1609
Mailing address
1930 BRANNAN RD, MCDONOUGH, GA 30253-4310
(678) 284-4040
(678) 284-4076
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D0704402
CLIA
GA
Enumeration date
01/23/2013
Last updated
05/06/2026
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