GEORGIA UROLOGY PA (NPI# 1417172602) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417172602 |
| Entity Type | Organization |
| Organization Name | GEORGIA UROLOGY PA |
| Practice Address |
3855 Pleasant Hill Rd Suite 220 Duluth GA 30096-1407 |
| Mailing Address |
1930 Brannan Rd Mcdonough GA 30253-4310 |
| Practice Telephone | 7709799427 |
| Practice Fax Number | 7709723846 |
| Mailing Telephone | 6782844040 |
| Mailing Fax Number | 6782844076 |
| Enumeration Date | 2007-04-15 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | CLIA | 11D1071375 | 01 |
| GA | CLIA | 11D0949712 | 01 |
| 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 |
3855 PLEASANT HILL RD SUITE 220 |
| City | DULUTH |
| State | GA |
| Zip Code | 30096-1407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013915586 | Michael John Pickford | Otolaryngology | 3855 Pleasant Hill Rd, Suite 280, Duluth, GA 30096-1407 | 2005-07-08 |
| 1831699958 | Regenerative Sports Medicine Inc | Orthopaedic Surgery | 3855 Pleasant Hill Rd, Duluth, GA 30096-1407 | 2018-02-15 |
| 1831639293 | Kelly Lynn Anderson | Specialist/Technologist | 3855 Pleasant Hill Rd, Suite 130, Duluth, GA 30096-1407 | 2017-03-06 |
| 1548709314 | Georgia Plastic Surgery Specialist | General Acute Care Hospital | 3855 Pleasant Hill Rd, Suite #300, Duluth, GA 30096-1407 | 2017-02-14 |
| 1215311402 | Cha Ob/gyn | Obstetrics & Gynecology | 3855 Pleasant Hill Rd, Suite 270, Duluth, GA 30096-1407 | 2015-07-17 |
| 1659794691 | Gwinnett Ear Nose & Throat, LLC | Otolaryngology | 3855 Pleasant Hill Rd, Suite 280, Duluth, GA 30096-1407 | 2014-01-28 |
| 1386083814 | Nicholas Matthew Rossi | Physician Assistant | 3855 Pleasant Hill Rd, Suite 470, Duluth, GA 30096-1407 | 2013-06-18 |
| 1811237571 | Ashley Lucia Feeney | Specialist/Technologist | 3855 Pleasant Hill Rd, Hudgens Building Suite 470, Duluth, GA 30096-1407 | 2013-02-18 |
| 1730438920 | David Robert Braatz | Audiologist | 3855 Pleasant Hill Rd, Suite 280, Duluth, GA 30096-1407 | 2012-09-03 |
| 1528334190 | Southern Plastic Surgery, P.C. | Specialist | 3855 Pleasant Hill Rd, Suite 370, Duluth, GA 30096-1407 | 2012-03-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922615897 | Georgia Eye Optical, LLC | Ophthalmology | 3800 Pleasant Hill Rd Ste 3, Duluth, GA 30096 | 2020-09-25 |
| 1568090868 | Positive Behavior Services, Inc | Behavior Technician | 3765 Crestwood Pkwy Nw, Duluth, GA 30096 | 2020-03-31 |
| 1861031940 | Elizabeth Ashley Edouard | Counselor | 3464 Duluth Hwy 120, Duluth, GA 30096 | 2020-01-06 |
| 1245701044 | Kathryn Irene Vaughn | Social Worker | 3968 Mainsail Court, Duluth, GA 30096 | 2018-12-06 |
| 1083184626 | Aica Orthopedics, P.C. | Orthopaedic Surgery | 3775 Venture Drive Bldg F, Duluth, GA 30096 | 2018-11-27 |
| 1245709799 | Positive Impact Health Centers, Inc. | Pharmacy | 3350 Breckinridge Blvd, Suite 200a, Duluth, GA 30096 | 2018-11-14 |
| 1235611724 | Katherine Winstead Knott | Counselor | 3460 Summit Ridge Parkway, Suite 503, Duluth, GA 30096 | 2018-08-31 |
| 1710467857 | Envision Optics LLC | Optometrist | 1943 Pleasant Hill Rd, Duluth, GA 30096 | 2018-08-17 |
| 1104314202 | Erin Mckernan Scupham | Chiropractor | 3820 Pleasant Hill Rd. Ne, Suite 4, Duluth, GA 30096 | 2018-04-25 |
| 1053839456 | Rogers Bridge Pediatric Therapy, LLC | Clinic/Center | 2845 Summercrest Ln, Duluth, GA 30096 | 2017-09-06 |
| Find all providers in zip 30096 | ||||
| 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 |
|---|---|---|---|---|
| 1487068904 | Joseph Song | Urology | 3855 Pleasant Hill Rd Ste 220, Duluth, GA 30096-8030 | 2014-06-12 |
| 1235564014 | David Morgan Rowland | Urology | 160 Surrey Park Ct, Duluth, GA 30097-1777 | 2013-09-11 |
| 1689094567 | Benjamin Michael Marsh | Urology | 400 E 3rd St, Duluth, MN 55805-1951 | 2014-04-18 |
| 1679831648 | Travis James Moncrief | Urology | 400 E 3rd St, Duluth, MN 55805-1951 | 2012-04-27 |
| 1487941993 | Rebekah Beach | Urology | 1001 E Superior St, Suite L201, Duluth, MN 55802-2207 | 2011-07-05 |
| 1184870404 | Nicholas Kahlert Johnson | Urology | 1001 E Superior St, Ste. L201, Duluth, MN 55802-2207 | 2008-08-18 |
| 1225296957 | Elizabeth Barbara Johnson | Urology | 1001 E Superior St, Ste. L201, Duluth, MN 55802-2207 | 2008-05-29 |
| 1942474481 | John R Stripling IIi Md LLC | Urology | 10700 Medlock Bridge Rd, Suite 204, Duluth, GA 30097-8456 | 2008-04-16 |
| 1588864755 | Andrew Sydney Nisbet | Urology | 1001 E Superior St, Ste. L201, Duluth, MN 55802-2207 | 2007-07-24 |
| 1760411565 | Martin Theodore Grune | Urology | 400 E 3rd St, Duluth, MN 55805-1951 | 2006-07-02 |
| Find all providers in DULUTH | ||||
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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.