Healthcare Provider Details

I. General information

NPI: 1518967546
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 MATTHEWS MINT HILL RD
MINT HILL NC
28105-3633
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-9920
  • Fax: 704-384-9925
Mailing address:
  • Phone: 704-384-9920
  • Fax: 704-384-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

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