Healthcare Provider Details

I. General information

NPI: 1760202303
Provider Name (Legal Business Name): NOVANT HEALTH TRIANGLE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 NW CARY PKWY STE 110
CARY NC
27513-8446
US

IV. Provider business mailing address

PO BOX 604337
CHARLOTTE NC
28260-4337
US

V. Phone/Fax

Practice location:
  • Phone: 919-238-2000
  • Fax: 919-238-5010
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LEEA JEANNIE WALTON
Title or Position: RCS MANAGER
Credential:
Phone: 336-515-7085