Healthcare Provider Details

I. General information

NPI: 1164792008
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 UNIVERSITY EXEC PARK DR SUITE 550
CHARLOTTE NC
28262-3383
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-3820
  • Fax: 704-316-3825
Mailing address:
  • Phone: 704-316-3820
  • Fax: 704-316-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEOFFREY GARDNER
Title or Position: VP FINANCE
Credential:
Phone: 704-384-7603