Healthcare Provider Details

I. General information

NPI: 1144143074
Provider Name (Legal Business Name): NOVANT HEALTH NORTHERN REGIONAL MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S SOUTH ST STE 200
MOUNT AIRY NC
27030-4590
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-786-6146
  • Fax: 336-786-8973
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LEEA WALTON
Title or Position: RCS MANAGER
Credential:
Phone: 704-316-6081