GEORGIA UROLOGY, PA (NPI# 1639499627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639499627 |
| Entity Type | Organization |
| Organization Name | GEORGIA UROLOGY, PA |
| Other Organization Name | GEORGIA UROLOGY ASC MARIETTA |
| Practice Address |
790 Church St Ne Suite 430 Marietta GA 30060-7282 |
| Mailing Address |
1930 Brannan Rd Mcdonough GA 30253-4310 |
| Practice Telephone | 7704299100 |
| Practice Fax Number | 7704291391 |
| Mailing Telephone | 6782844040 |
| Mailing Fax Number | 6782844076 |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2015-01-23 |
| 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 | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Georgia Urology ASC Marietta | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093369795 | Georgia Urology, Pa | Urology | 470 Northside Cherokee Blvd Ste 210, Canton, GA 30115-8029 | 2019-07-31 |
| 1699328369 | Georgia Urology, Pa | Clinic/Center | 1670 Scott Blvd Ste 204k, Decatur, GA 30033-5645 | 2019-07-22 |
| 1952771230 | Georgia Urology, Pa | Clinic/Center | 3400 Old Milton Pkwy Ste C535, Alpharetta, GA 30005-4456 | 2015-09-30 |
| 1629222815 | Georgia Urology, Pa | Clinic/Center | 1301 Sigman Rd Ne Ste 250b, Conyers, GA 30012-3812 | 2008-11-14 |
| 1003428590 | Georgia Urology, Pa | Urology | 4150 Deputy Bill Cantrell Memorial Rd., Suite 140a, Cumming, GA 30040 | 2020-08-18 |
| 1245875236 | Georgia Urology, Pa | Urology | 631 Professional Dr Ste 490, Lawrenceville, GA 30046-3370 | 2019-11-13 |
| 1083268783 | Georgia Urology, Pa | Urology | 120 Trinity Pl, Athens, GA 30607-2100 | 2019-07-31 |
| Street Address |
790 CHURCH ST NE SUITE 430 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-7282 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720083702 | Roberto A. Larrivey | Otolaryngology | 790 Church St Ne, Ste 140, Marietta, GA 30060-8902 | 2005-06-16 |
| 1003356361 | Proactive Physicians of Marietta, PC | Clinic/Center | 790 Church St Ne, Suite 220, Marietta, GA 30060-7282 | 2017-03-06 |
| 1720535529 | Tracy Zoblisein | Pharmacist | 790 Church St Ne, Suite 335, Marietta, GA 30060-7282 | 2016-09-09 |
| 1609323641 | Lisa Long | Pharmacist | 790 Church St Ne, Suite 335, Marietta, GA 30060-7282 | 2016-09-07 |
| 1306293113 | Kristina L Thomas | Nurse Practitioner | 790 Church St Ne, Suite 150, Marietta, GA 30060-7282 | 2016-05-21 |
| 1447681218 | James Wesley Garrett | Physician Assistant | 790 Church St Ne, Ste 400, Marietta, GA 30060-7282 | 2013-12-04 |
| 1396083606 | Deborah Luann Hurd | Nurse Practitioner | 790 Church St Ne, Suite 330, Marietta, GA 30060-7282 | 2013-01-21 |
| 1336485457 | Paradigm Medical LLC | Specialist | 790 Church St Ne, Suite 410, Marietta, GA 30060-7282 | 2012-12-18 |
| 1679824742 | Nsh Cancer Institute Professional Services G LLC | Durable Medical Equipment & Medical Supplies | 790 Church St Ne, Suite 335, Marietta, GA 30060-7282 | 2012-09-28 |
| 1568724052 | Brandon M Paritz | Family Medicine | 790 Church St Ne, Suite 250, Marietta, GA 30060-7282 | 2012-06-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285108845 | Marietta Advanced Surgery Center | Clinic/Center | 1371 Church Street Ext Ne Ste 100, Marietta, GA 30060-7913 | 2019-01-17 |
| 1700369071 | Alliance Surgery Center At Marietta, LLC | Clinic/Center | 400 Tower Rd Ne Ste 375, Marietta, GA 30060-9417 | 2018-09-12 |
| 1952814352 | Medici Surgical Center, LLC | Clinic/Center | 792 Church St Ne Ste 101, Marietta, GA 30060-7291 | 2017-11-08 |
| 1770004772 | Northwest Atlanta Vascular Care LLC | Clinic/Center | 711 Canton Rd Ne Ste 230, Marietta, GA 30060-8949 | 2017-06-29 |
| 1568864452 | Carpus Surgery Center LLC | Clinic/Center | 3775 Roswell Rd, Suite 275, Marietta, GA 30062-8836 | 2014-09-23 |
| 1881001758 | Asuch Surgery Center | Clinic/Center | 2285 Asquith Ave Sw, Suite 100, Marietta, GA 30008-6008 | 2014-07-12 |
| 1235559378 | Skin Cancer Specialists Surgery Center, LLC | Clinic/Center | 835 Cogburn Ave Nw, Suite 200, Marietta, GA 30060-1031 | 2014-04-16 |
| 1801224167 | Roquin Pain Center | Clinic/Center | 1121 Johnson Ferry Rd, Suite 340, Marietta, GA 30068-5425 | 2013-10-24 |
| 1750629325 | Premier Ambulatory Surgical Center, LLC | Clinic/Center | 211 Chicopee Dr Ne, Marietta, GA 30060-1269 | 2013-01-16 |
| 1538306709 | Georgia Electro Diagnostic Providers P.C. | Clinic/Center | 2550 Windy Hill Rd, Suite 215, Marietta, GA 30067-8654 | 2009-01-09 |
| Find all providers in MARIETTA | ||||
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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.