Healthcare Provider Details

I. General information

NPI: 1487866703
Provider Name (Legal Business Name): FREDERICK W. JENNART DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 HOSPITAL DRIVE SUITE N
WARNER ROBINS GA
31088-4294
US

IV. Provider business mailing address

212 HOSPITAL DRIVE SUITE N
WARNER ROBINS GA
31088-4294
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-6698
  • Fax: 478-922-4558
Mailing address:
  • Phone: 478-922-6698
  • Fax: 478-922-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDERICK W JENNART
Title or Position: PHYSICIAN
Credential: DO
Phone: 478-922-6698