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General NPI Number Information
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NPI Number | 1528406386
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Entity Type | Organization
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Legal Business Name | NOVANT HEALTH MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 13815 PROFESSIONAL CENTER DR STE 300
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-7950
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Country | US
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Telephone | 704-316-2050
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Fax | 704-316-2051
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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 | 704-316-2050
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Fax | 704-316-2051
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Authorized Official
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Title or Position | RCS MANAGER
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Name | LEEA JEANINE 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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 33780
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease 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 | 2084N0400X
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Taxonomy Name | Neurology 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 | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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