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NPI Code Detail

MEDICARE: NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC

MEDICARE: NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician

General Provider Information

NPI Number : 1164250031
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Provider Business Mailing Address
First Line : PO BOX 936857
Second Line :
City : ATLANTA
State : GA
Zip : 31193-6857
Country : US
Telephone Number : 910-662-9384
Fax Number : 910-667-2566
Provider Business Practice Location Address
First Line : 1726 NEW HANOVER MEDICAL PARK DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-5344
Country : US
Telephone Number : 910-662-9384
Fax Number : 910-667-2566
Authorized Official
Title or Position : ENROLLMENT MANAGER
Name : LEEA JEANINE WALTON
Credential :
Telephone Number : 336-515-7085
Provider Enumeration Date : 07/23/2024
Last Update Date : 07/23/2024

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Directions to “NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC ” Practice Location

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