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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 : 1497687776
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 :
Fax Number :
Provider Business Practice Location Address
First Line : 2739 IRON GATE DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28412-3731
Country : US
Telephone Number : 910-763-7363
Fax Number : 910-251-8296
Authorized Official
Title or Position : RCS MANAGER
Name : LEEA JEANINE WALTON
Credential :
Telephone Number : 704-316-6081
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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

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