Healthcare Provider Details

I. General information

NPI: 1720439870
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S COLLEGE ST SUITE 250
CHARLOTTE NC
28202-6000
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1620
  • Fax: 704-384-1626
Mailing address:
  • Phone: 704-384-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEOFFREY K. GARDNER
Title or Position: VP OF FINANCE
Credential:
Phone: 704-384-7680