Provider Demographics
NPI:1487866703
Name:FREDERICK W. JENNART DO PC
Entity Type:Organization
Organization Name:FREDERICK W. JENNART DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:JENNART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:478-922-6698
Mailing Address - Street 1:212 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-4294
Mailing Address - Country:US
Mailing Address - Phone:478-922-6698
Mailing Address - Fax:478-922-4558
Practice Address - Street 1:212 HOSPITAL DRIVE
Practice Address - Street 2:SUITE N
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-4294
Practice Address - Country:US
Practice Address - Phone:478-922-6698
Practice Address - Fax:478-922-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2673Medicare ID - Type Unspecified