Healthcare Provider Details

I. General information

NPI: 1679888978
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 PROSPERITY CHURCH RD
HUNTERSVILLE NC
28078-6698
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-4830
  • Fax: 704-316-4831
Mailing address:
  • Phone: 704-316-4830
  • Fax: 704-316-4831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEOFFREY K. GARDNER
Title or Position: VP FINANCE
Credential:
Phone: 704-384-7283