Provider Demographics
NPI:1821001025
Name:JENNART, FREDERICK W (DO)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:W
Last Name:JENNART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HOSPITAL DR
Mailing Address - Street 2:STE N
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:478-922-6698
Mailing Address - Fax:478-922-4558
Practice Address - Street 1:212 HOSPITAL DR
Practice Address - Street 2:STE N
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-922-6698
Practice Address - Fax:478-922-4558
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0333652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00425653AMedicaid
E68699Medicare UPIN
GA00425653AMedicaid