Provider Demographics
NPI:1952771230
Name:GEORGIA UROLOGY, PA
Entity Type:Organization
Organization Name:GEORGIA UROLOGY, PA
Other - Org Name:GA UROLOGY ASC ROSWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-284-4049
Mailing Address - Street 1:11835 ALPHARETTA HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4929
Mailing Address - Country:US
Mailing Address - Phone:770-772-4427
Mailing Address - Fax:770-772-4428
Practice Address - Street 1:11835 ALPHARETTA HWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4929
Practice Address - Country:US
Practice Address - Phone:770-475-7550
Practice Address - Fax:770-343-9080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA UROLOGY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-30
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical