GEORGIA UROLOGY PA (NPI# 1881932010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881932010 |
| Entity Type | Organization |
| Organization Name | GEORGIA UROLOGY PA |
| Practice Address |
1275 Highway 54 W Suite 205 Fayetteville GA 30214-4549 |
| Mailing Address |
1930 Brannan Rd Mcdonough GA 30253-4310 |
| Practice Telephone | 7707169656 |
| Practice Fax Number | 7707161609 |
| Mailing Telephone | 6782844040 |
| Mailing Fax Number | 6782844076 |
| Enumeration Date | 2013-01-23 |
| 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 | 2088P0231X |
Urology Specialization: Pediatric Urology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | CLIA | 11D0704402 | 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 |
1275 HIGHWAY 54 W SUITE 205 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-4549 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619962503 | P E T Imaging of Fayette LLC | Radiology | 1275 Highway 54 W, Ste 102, Fayetteville, GA 30214-4549 | 2005-09-16 |
| 1952843013 | William Matthew Mowery | Physical Therapy Assistant | 1275 Highway 54 W, Ste 200, Fayetteville, GA 30214-4549 | 2016-11-07 |
| 1013311224 | Drayton Thomas Perkins | Physical Therapist | 1275 Highway 54 W, Ste 200, Fayetteville, GA 30214-4549 | 2014-10-17 |
| 1609283225 | Matthew Watson | Physical Therapist | 1275 Highway 54 W, Ste 200, Fayetteville, GA 30214-4549 | 2014-07-15 |
| 1467888560 | Daniel John Voight | Physical Therapist | 1275 Highway 54 W, Ste 200, Fayetteville, GA 30214-4549 | 2013-09-20 |
| 1457686917 | Aaron H Honeycutt | Physical Therapist | 1275 Highway 54 W, Suite 200, Fayetteville, GA 30214-4549 | 2009-10-16 |
| 1982838561 | Anthony Joseph Braim | Physical Therapist | 1275 Highway 54 W, Ste 200, Fayetteville, GA 30214-4549 | 2009-05-11 |
| 1447402086 | John W Sims | Nurse Practitioner | 1275 Highway 54 W, Suite 200, Fayetteville, GA 30214-4549 | 2008-10-15 |
| 1982877197 | Sleep Services of America | Clinical Medical Laboratory | 1275 Highway 54 W, Suite 203, Fayetteville, GA 30214-4549 | 2008-04-09 |
| 1801068754 | J. Rena Owsley-brown | Dentist | 1275 Highway 54 W, Suite 204, Fayetteville, GA 30214-4549 | 2008-04-01 |
| 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 | 2088P0231X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| Specialization | Pediatric Urology |
| Surgeons who can diagnose, treat, and manage children’s urinary and genital problems. A pediatric urologist devotes a minimum of 50% of his or her practice to the urologic problems of infants, children, and adolescents. Pediatric urologists generally provide the following services: the evaluation and management of voiding disorders; vesicoureteral reflux, and urinary tract infections that require surgery; surgical reconstruction of the urinary tract (kidneys, ureters, and bladder) including genital abnormalities, hypospadias, and intersex conditions; surgery for groin conditions in childhood and adolescence (undescended testes, hydrocele/hernia, varicocele). |
| Notes: Source: American Academy of Pediatrics [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346422995 | North Georgia Urology Group, P.C. | Urology | 101 Professional Ct Se, Calhoun, GA 30701-7036 | 2007-12-05 |
| 1033280656 | Eduardo L Rojas | Urology | 360 Cumberland Dr Ne, Calhoun, GA 30701-4727 | 2006-11-13 |
| 1871588277 | David J Riden | Urology | 3747 Roswell Rd Ste 201, Marietta, GA 30062 | 2005-09-13 |
| 1770942856 | Georgia Urology Pediatric LLC | Urology | 5730 Glenridge Dr, Ste 200, Atlanta, GA 30328-6141 | 2016-02-17 |
| 1508125865 | Shuvro De | Urology | 5730 Glenridge Dr Ste 200, Atlanta, GA 30328-5579 | 2012-05-08 |
| 1912137431 | Emily Blum | Urology | 5730 Glenridge Dr Ste 200, Atlanta, GA 30328-5579 | 2009-07-17 |
| 1891993374 | Wolfgang Hans Cerwinka | Urology | 5445 Meridian Marks Rd Ne, Suite 420, Atlanta, GA 30342-4763 | 2007-07-06 |
| 1700088929 | Paul Michael Zmaj | Urology | 3747 Roswell Rd Ste 201, Marietta, GA 30062 | 2007-06-01 |
| 1174749055 | Georgia Urology Pa | Urology | 5445 Meridian Marks Rd Ne, Suite 420, Atlanta, GA 30342-4763 | 2007-04-18 |
| 1649338278 | Glynn Urologists, P.C. | Urology | 2418 Parkwood Dr, Brunswick, GA 31520-4721 | 2006-12-05 |
| Find all providers with the same taxonomy | ||||
| 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.