Healthcare Provider Details

I. General information

NPI: 1699328047
Provider Name (Legal Business Name): NOVANT MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LANGTREE VILLAGE DR STE 200
MOORESVILLE NC
28117-7571
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-9900
  • Fax: 704-384-9917
Mailing address:
  • Phone: 704-384-9900
  • Fax: 704-384-9917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SHALA DAVIS
Title or Position: MANAGED CARE ENROLLMENT MANAGER
Credential:
Phone: 704-316-7845