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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