Provider Demographics
NPI:1912978065
Name:FERNANDEZ, ENRIQUE J (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2500 STARLING ST STE 501
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4270
Mailing Address - Country:US
Mailing Address - Phone:912-466-5503
Mailing Address - Fax:912-466-5553
Practice Address - Street 1:2500 STARLING ST STE 501
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4270
Practice Address - Country:US
Practice Address - Phone:912-466-5503
Practice Address - Fax:912-466-5553
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0361522084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000518647JMedicaid
GA#000518647JMedicaid
GA#000518647JMedicaid
#GRP6883Medicare PIN
GA000518647JMedicaid