Healthcare Provider Details

I. General information

NPI: 1710352927
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 BROAD ST SUITE D
KERNERSVILLE NC
27284-2796
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-7470
  • Fax: 336-765-6440
Mailing address:
  • Phone: 336-718-7470
  • Fax: 336-765-6440

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: GEOFFREY K GARDNER
Title or Position: VP OF FINANCE
Credential:
Phone: 704-384-7606