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General NPI Number Information
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NPI Number | 1134943459
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Entity Type | Organization
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Legal Business Name | NOVANT HEALTH SOUTHEASTERN SPINE INSTITUTE, LLC
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1625 HOSPITAL DR
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City | MT PLEASANT
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State | SC
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Zip | 29464-3698
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Country | US
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Telephone | 843-849-1551
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Fax | 843-884-0629
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Provider Business Mailing Address
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Address Line | 2085 FRONTIS PLAZA BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5614
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RCS MANAGER
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Name | LEEA WALTON
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Credential |
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Telephone | 704-316-6081
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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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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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