Healthcare Provider Details

I. General information

NPI: 1790949816
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ENDO LN STE 1 DBA THE SANDHILLS MEDICAL GROUP
HAMLET NC
28345-4560
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 910-205-8909
  • Fax: 910-205-8952
Mailing address:
  • Phone: 910-205-8909
  • Fax: 910-205-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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