Healthcare Provider Details

I. General information

NPI: 1992401152
Provider Name (Legal Business Name): BERNARD A ROYAL JR. APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 GRAEME DR
MCDONOUGH GA
30252-7238
US

IV. Provider business mailing address

853 GRAEME DR
MCDONOUGH GA
30252-7238
US

V. Phone/Fax

Practice location:
  • Phone: 347-791-9145
  • Fax:
Mailing address:
  • Phone: 347-791-9145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP266345
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1117209
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: