Healthcare Provider Details

I. General information

NPI: 1093292997
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6316 OLD OAK RIDGE RD STE E
GREENSBORO NC
27410-9940
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-992-1351
  • Fax: 336-992-1361
Mailing address:
  • Phone: 336-992-1351
  • Fax: 336-992-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: SHALA DAVIS
Title or Position: MANAGER OF MANAGED CARE ENROLLMENT
Credential:
Phone: 704-316-7845