Healthcare Provider Details

I. General information

NPI: 1760282487
Provider Name (Legal Business Name): NOVANT HEALTH PIEDMONT NORTH CAROLINA MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 BRAXTON LN STE 101
GREENSBORO NC
27408-2862
US

IV. Provider business mailing address

PO BOX 604345
CHARLOTTE NC
28260-4345
US

V. Phone/Fax

Practice location:
  • Phone: 336-333-6306
  • Fax: 336-333-6309
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

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