Healthcare Provider Details

I. General information

NPI: 1851635460
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 DALE EARNHARDT BLVD
KANNAPOLIS NC
28083-4477
US

IV. Provider business mailing address

PO BOX 602362
CHARLOTTE NC
28260-2362
US

V. Phone/Fax

Practice location:
  • Phone: 704-216-5633
  • Fax: 704-639-0785
Mailing address:
  • Phone: 704-216-5633
  • Fax: 704-639-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GEOFFREY K GARDNER
Title or Position: VP OF FINANCE
Credential:
Phone: 704-216-5633