Healthcare Provider Details

I. General information

NPI: 1629262548
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 COPPERFIELD BLVD NE
CONCORD NC
28025-2433
US

IV. Provider business mailing address

650 STATESVILLE BLVD BOX 4
SALISBURY NC
28144-2284
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-7310
  • Fax: 704-384-7311
Mailing address:
  • Phone: 704-637-1123
  • Fax: 704-637-1214

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEOFFREY GARDNER
Title or Position: VP OF FINANCE
Credential:
Phone: 704-384-9104