Healthcare Provider Details

I. General information

NPI: 1699960468
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25805 ANDREW JACKSON HIGHWAY E
DELCO NC
28436-8916
US

IV. Provider business mailing address

25805 ANDREW JACKSON HWY E
DELCO NC
28436-8916
US

V. Phone/Fax

Practice location:
  • Phone: 910-655-9900
  • Fax: 910-655-9907
Mailing address:
  • Phone: 910-655-9900
  • Fax: 910-655-9907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DINESH S PAI
Title or Position: VP OF OPERATIONS
Credential:
Phone: 704-384-9104