Healthcare Provider Details

I. General information

NPI: 1063108033
Provider Name (Legal Business Name): NOVANT HEALTH THOMASVILLE MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 W MARKET ST STE 300
GREENSBORO NC
27403-4442
US

IV. Provider business mailing address

PO BOX 935983
ATLANTA GA
31193-5983
US

V. Phone/Fax

Practice location:
  • Phone: 336-660-5540
  • Fax: 336-660-5559
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: LEEA JEANINE WALTON
Title or Position: RCS MANAGER
Credential:
Phone: 704-316-6081