Provider Demographics
NPI:1992401152
Name:ROYAL, BERNARD A JR (APRN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:A
Last Name:ROYAL
Suffix:JR
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 GRAEME DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-7238
Mailing Address - Country:US
Mailing Address - Phone:347-791-9145
Mailing Address - Fax:
Practice Address - Street 1:315 14TH ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5305
Practice Address - Country:US
Practice Address - Phone:404-691-8880
Practice Address - Fax:404-691-8811
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1117209363LF0000X, 363LF0000X
GARN266345363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily