Provider Demographics
NPI:1750787834
Name:ROVNER, FREDERICK BENJAMIN KAY
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:BENJAMIN KAY
Last Name:ROVNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4756 HABERSHAM RDG SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5603
Mailing Address - Country:US
Mailing Address - Phone:404-545-5787
Mailing Address - Fax:770-972-1672
Practice Address - Street 1:4756 HABERSHAM RDG SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-5603
Practice Address - Country:US
Practice Address - Phone:404-545-5787
Practice Address - Fax:770-972-1672
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily