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General NPI Number Information
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NPI Number | 1205836434
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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 | 07/29/2005
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 1718 E 4TH ST STE 501
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City | CHARLOTTE
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State | NC
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Zip | 28204-3260
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Country | US
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Telephone | 704-887-7563
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Fax | 704-887-7570
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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 | VP OF OPERATIONS
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Name | GEOFFREY GARDNER
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Credential |
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Telephone | 704-384-9104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease 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 | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology 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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) 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 | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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