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General NPI Number Information
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NPI Number | 1043486483
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Entity Type | Organization
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Legal Business Name | NOVANT MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 5107 SOUTHPARK DR SUITE 104
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City | DURHAM
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State | NC
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Zip | 27713-8400
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Country | US
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Telephone | 919-477-6900
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Fax | 919-544-6210
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 919-477-6900
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Fax | 919-544-6210
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Authorized Official
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Title or Position | RCS MGR
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Name | SHALA DAVIS
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Credential |
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Telephone | 704-303-7517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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