MEDICARE: NOVANT MEDICAL GROUP INC

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
1	207RC0000X	Cardiovascular Disease Physician
2	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295092856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVANT MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	336-277-1890
Fax Number	:	336-277-1889

Provider Business Practice Location Address
First Line	:	4130 CLEMMONS RD
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-7520
Country	:	US
Telephone Number	:	336-277-1890
Fax Number	:	336-277-1889

Authorized Official
Title or Position	:	VP FINANCE, NMG
Name	:	MR. GEOFFREY K GARDNER
Credential	:
Telephone Number	:	336-718-6770

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	12/18/2015

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