GEORGIA UROLOGY PA (NPI# 1407194558) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407194558 |
| Entity Type | Organization |
| Organization Name | GEORGIA UROLOGY PA |
| Practice Address |
1267 Highway 54 W Suite 5200 Fayetteville GA 30214-2114 |
| Mailing Address |
1930 Brannan Rd Mcdonough GA 30253-4310 |
| Practice Telephone | 7770460977 |
| Mailing Telephone | 6782844040 |
| Mailing Fax Number | 6782844076 |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2015-01-28 |
| Authorized Official Name | DR. MARK A HABER (MANAGING PARTNER) |
| Authorized Official Telephone | 6782844049 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | GEORGIA UROLOGY PA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265995724 | Georgia Urology Pa | Non-Pharmacy Dispensing Site | 5900 Hillandale Dr Ste 200, Lithonia, GA 30058-3858 | 2019-04-11 |
| 1447772348 | Georgia Urology Pa | Urology | 4800 Olde Towne Pkwy Ste 220, Marietta, GA 30068-4391 | 2017-07-12 |
| 1154855740 | Georgia Urology Pa | Urology | 2161 W Spring St., Suite C, Monroe, GA 30655-3196 | 2017-04-20 |
| 1720510241 | Georgia Urology Pa | Urology | 1110 W Peachtree St Nw Ste 1020, Atlanta, GA 30309-3609 | 2017-04-03 |
| 1184089989 | Georgia Urology Pa | Urology | 2151b West Spring St, Ste 210, Monroe, GA 30655-3115 | 2015-12-21 |
| 1528308988 | Georgia Urology Pa | Urology | 1357 Hembree Rd Ste 250, Roswell, GA 30076-5724 | 2013-02-21 |
| 1821261744 | Georgia Urology Pa | Urology | 200 Dawson Commons Circle, Dawsonville, GA 30534 | 2008-04-11 |
| 1508081795 | Georgia Urology Pa | Urology | 4645 Timber Ridge Dr Ste 120, Douglasville, GA 30135-7542 | 2007-04-15 |
| 1871144246 | Georgia Urology Pa | Urology | 1670 Scott Blvd Ste 204k, Decatur, GA 30033-5645 | 2019-09-26 |
| 1073028643 | Georgia Urology Pa | Urology | 4150 Deputy Bill Cantrell Memorial Road, Suite 140b, Cumming, GA 30040 | 2017-12-05 |
| Street Address |
1267 HIGHWAY 54 W SUITE 5200 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-2114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912902107 | Charles William Pettus | Internal Medicine | 1267 Highway 54 W, Ste 2200, Fayetteville, GA 30214-2114 | 2005-06-15 |
| 1528466679 | Kelly Teed | Genetic Counselor, MS | 1267 Highway 54 W, Suite 4000, Fayetteville, GA 30214-2114 | 2014-12-05 |
| 1811398233 | Leah Keith | Nurse Practitioner | 1267 Highway 54 W, Suite 2200, Fayetteville, GA 30214-2114 | 2014-09-05 |
| 1083024095 | Hannah Katharine Shell | Nurse Practitioner | 1267 Highway 54 W, Ste 2200, Fayetteville, GA 30214-2114 | 2014-04-29 |
| 1750679775 | Lilibird Pichardo | Obstetrics & Gynecology | 1267 Highway 54 W, Suite 3200, Fayetteville, GA 30214-2114 | 2011-07-11 |
| 1598080129 | David G Tian | Internal Medicine | 1267 Highway 54 W, Suite 2200, Fayetteville, GA 30214-2114 | 2010-04-07 |
| 1871720003 | Joseph Lavallo | Nurse Practitioner | 1267 Highway 54 W, Suite 2200, Fayetteville, GA 30214-2114 | 2009-06-15 |
| 1477714517 | Ryan K. Crisel | Internal Medicine | 1267 Highway 54 W, Suite 2200, Fayetteville, GA 30214-2110 | 2008-06-20 |
| 1740447820 | David Jaehan Yoo | Internal Medicine | 1267 Highway 54 W, Suite 5400, Fayetteville, GA 30214-2114 | 2008-05-17 |
| 1184800534 | Sanjay Sarin | Internal Medicine | 1267 Highway 54 W, Suite 2200, Fayetteville, GA 30214-2114 | 2008-01-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679581003 | Carolina Lithotripsy Ldt | Urology | 2014 Litho Place, Fayetteville, NC 28304 | 2006-08-03 |
| 1003873050 | Richard D Mcwhorter | Urology | 2 East Appleby Rd., Suite 201, Fayetteville, AR 72703 | 2006-04-26 |
| 1881656924 | Fayetteville Urology Associates Pa | Urology | 1786 Metromedical Drive, Fayetteville, NC 28304 | 2006-04-04 |
| 1801860630 | Philip R Kreitzer | Urology | 4211 Medical Center Dr, Suite 211, Fayetteville, NY 13066-6637 | 2006-02-16 |
| 1861476897 | Nirmal K Kilambi | Urology | 1300 E Zion Rd, Fayetteville, AR 72703-5015 | 2005-12-02 |
| 1013912369 | Albert Vazquez Lugo | Urology | 7300 S Raeford Rd, Fayetteville, NC 28304-6162 | 2005-06-14 |
| 1124022561 | Henry Edward Parfitt Jr. | Urology | 1786 Metromedical Dr, Fayetteville, NC 28304-3861 | 2005-06-13 |
| 1861026619 | Georgia Urology Piedmont, LLC | Urology | 1336 Highway 54 W Bldg 200, Fayetteville, GA 30214-4574 | 2020-03-02 |
| 1548755903 | Cumberland County Hospital System Inc | Urology | 1537 Owen Park Ln, Fayetteville, NC 28304-3454 | 2018-06-28 |
| 1295122315 | Mark William Pickhardt | Urology | 3232 N Northhills Blvd, Fayetteville, AR 72703-4005 | 2015-04-16 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.