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General NPI Number Information
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NPI Number | 1407194558
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Entity Type | Organization
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Legal Business Name | GEORGIA UROLOGY PA
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 1267 HIGHWAY 54 W SUITE 5200
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2114
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Country | US
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Telephone | 777-046-0977
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 BRANNAN RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-4310
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Country | US
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Telephone | 678-284-4040
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Fax | 678-284-4076
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. MARK A HABER
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Credential | M.D.
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Telephone | 678-284-4049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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