Healthcare Provider Details

I. General information

NPI: 1952107385
Provider Name (Legal Business Name): NOVANT HEALTH PREP II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 CARMEL EXECUTIVE PARK DR STE 200
CHARLOTTE NC
28226-1336
US

IV. Provider business mailing address

2085 FRONTIS PLAZA BLVD
WINSTON SALEM NC
27103-5614
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-0741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

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