Healthcare Provider Details

I. General information

NPI: 1568376945
Provider Name (Legal Business Name): NOVANT HEALTH NORTHERN REGIONAL MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S SOUTH ST
MOUNT AIRY NC
27030-4422
US

IV. Provider business mailing address

PO BOX 604546
CHARLOTTE NC
28260-4546
US

V. Phone/Fax

Practice location:
  • Phone: 336-786-4522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

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