Healthcare Provider Details

I. General information

NPI: 1235924846
Provider Name (Legal Business Name): NOVANT HEALTH ENTERPRISES IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 BALLANTYNE MEDICAL PL STE 100
CHARLOTTE NC
28277-0745
US

IV. Provider business mailing address

15825 BALLANTYNE MEDICAL PL STE 100
CHARLOTTE NC
28277-0745
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-3426
  • Fax: 704-323-3402
Mailing address:
  • Phone: 704-323-3426
  • Fax: 704-323-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WADE COLLINS
Title or Position: VP OF NOVANT HEALTH VENTURES
Credential:
Phone: 423-677-0679