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General NPI Number Information
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NPI Number | 1043495005
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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 | 01/08/2008
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 902 NORTH HOWE STREET
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City | SOUTHPORT
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State | NC
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Zip | 28461-3038
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Country | US
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Telephone | 910-457-4789
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 602362
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City | CHARLOTTE
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State | NC
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Zip | 28260-2362
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Country | US
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Telephone | 704-384-7840
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Fax |
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Authorized Official
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Title or Position | SENIOR VP COO OF NMG
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Name | MICHELLE GRIER
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Credential |
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Telephone | 704-384-7607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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