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	207Q00000X	Family Medicine Physician

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	:	1376593590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVANT MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 602362
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2362
Country	:	US
Telephone Number	:	704-384-7840
Fax Number	:	704-384-7830

Provider Business Practice Location Address
First Line	:	207 CHURCH ST
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-1008
Country	:	US
Telephone Number	:	803-222-3063
Fax Number	:	803-222-3064

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	GEOFFREY GARDNER
Credential	:
Telephone Number	:	704-384-9094

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	06/27/2013

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Directions to “NOVANT MEDICAL GROUP, INC. ” Practice Location

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