GEORGIA UROLOGY PA (NPI# 1235354424) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235354424 |
| Entity Type | Organization |
| Organization Name | GEORGIA UROLOGY PA |
| Practice Address |
220 J L White Dr Suite 160 Jasper GA 30143-4893 |
| Mailing Address |
1930 Brannan Rd Mcdonough GA 30253-4310 |
| Practice Telephone | 7066924384 |
| Practice Fax Number | 7066922504 |
| 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 | 11D0891563 | 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 |
220 J L WHITE DR SUITE 160 |
| City | JASPER |
| State | GA |
| Zip Code | 30143-4893 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548265838 | Walter Kenneth Austin Jr. | Internal Medicine | 220 J L White Dr, Suite 100, Jasper, GA 30143-4893 | 2005-06-14 |
| 1336542943 | Kellie Pack | Nurse Practitioner | 220 J L White Dr, Suite 120, Jasper, GA 30143-4893 | 2014-09-27 |
| 1639466287 | Tansy Ridings | Physician Assistant | 220 J L White Dr, Suite 160, Jasper, GA 30143-4893 | 2011-07-05 |
| 1386885069 | Jason Fleury | Physician Assistant | 220 J L White Dr, Suite 100, Jasper, GA 30143-4893 | 2009-03-10 |
| 1457517146 | Wanda Denise Correia | Nurse Practitioner | 220 J L White Dr, Suite 110, Jasper, GA 30143-4894 | 2008-08-01 |
| 1528267705 | Kawami R. Clay | Legal Medicine | 220 J L White Dr, Suite 120, Jasper, GA 30143-4893 | 2007-07-17 |
| 1972701936 | Mark Andrew Supan | Obstetrics & Gynecology | 220 J L White Dr, Suite 120, Jasper, GA 30143-4893 | 2007-07-10 |
| 1225253842 | Womens Specialty Center of North Georgia | Obstetrics & Gynecology | 220 J L White Dr, Suite 120, Jasper, GA 30143-4893 | 2007-04-17 |
| 1962572875 | Sara L Williams | Nurse Practitioner | 220 J L White Dr, Suite 100, Jasper, GA 30143-4893 | 2006-11-08 |
| 1588759336 | Cardiac Disease Specialists, PC | Internal Medicine | 220 J L White Dr, Ste 100, Jasper, GA 30143-4893 | 2006-10-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073111845 | George Mackel, Pmhnp-bc, LLC | Nurse Practitioner | 12034 Big Canoe, 400 Shetland Trace, Jasper, GA 30143 | 2020-10-14 |
| 1598363434 | Amanda J Griggs | Massage Therapist | 54 Wolfscratch Village, Jasper, GA 30143 | 2020-10-13 |
| 1801397724 | Jema Day | Nurse Practitioner | 620 J L White Dr Ste 140, Jasper, GA 30143 | 2018-02-26 |
| 1023467545 | North Georgia Personal Care LLC | Home Health | 501 North Main St., Suite B, Jasper, GA 30143 | 2016-06-06 |
| 1871979641 | Sj & J Spine and Pain Group Holding LLC | Pain Medicine | 91 Sammy Mcghee Blvd, Suite 101, Jasper, GA 30143 | 2015-08-04 |
| 1801294293 | Highland Recovery Center | Community/Behavioral Health | 323 Roland Road, Jasper, GA 30143 | 2014-12-17 |
| 1770905861 | Leslie Rhea Hanagan | Speech-Language Pathologist | 22 Dogwood Lane, Jaser, GA 30143 | 2014-01-09 |
| 1669800660 | Pickens County Chiropractic | Chiropractor | 95 North Main Street, Jasper, GA 30143 | 2013-10-29 |
| 1407139264 | Rocky Mountain Holdings LLC | Ambulance | 70 Airport Business Court, Jasper, GA 30143 | 2011-09-27 |
| 1851681415 | Richard J Vandam | Internal Medicine | 1266 Highway 515, Piedmont Mountainside Hospital, Jasper, GA 30143 | 2011-04-15 |
| Find all providers in zip 30143 | ||||
| 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 |
|---|---|---|---|---|
| 1821353814 | Little Company of Mary Hospital of Indiana Inc | Urology | 600 W 13th Street, Suite 105, Jasper, IN 47546-1882 | 2012-07-06 |
| 1811187420 | Kristopher Harper Gunn | Urology | 600 W 13th St, Suite 105, Jasper, IN 47546-1881 | 2007-07-30 |
| 1902951312 | Urology Specialists PC | Urology | 1950 St Charles Street, Suite 3, Jasper, IN 47546 | 2007-01-24 |
| 1639281595 | Peter Strom Selikoff | Urology | 6610 Curry Hwy, Jasper, AL 35503-5664 | 2006-08-31 |
| 1811940679 | Alan Clayton Mccool | Urology | 3400 Highway 78 E Ste 412, Jasper, AL 35501-8952 | 2006-05-19 |
| 1457506172 | Bhc-jasper Urology Associates | Urology | 3400 Highway 78 E, Suite 412, Jasper, AL 35501-8907 | 2008-11-21 |
| 1427134147 | Sequatchie Valley Urology LLC | Urology | 1000 Highway 28, Jasper, TN 37347-3638 | 2006-10-27 |
| 1417051590 | Joel A Rosenfeld | Urology | 220 J L White Dr, Suite 160, Jasper, GA 30143-4893 | 2006-09-11 |
| 1235241100 | James Owen Moon | Urology | 3400 Highway 78 E, 412 Medical Arts Tower, Jasper, AL 35501-8907 | 2006-08-31 |
| 1376589499 | Richard Lawrence Levine | Urology | 980 Highway 28, Suite 201, Jasper, TN 37347-3695 | 2006-06-20 |
| Find all providers in JASPER | ||||
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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.