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General NPI Number Information
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NPI Number | 1588610471
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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 | 05/25/2006
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 1900 RANDOLPH ROAD SUITE 800
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City | CHARLOTTE
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State | NC
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Zip | 28207-1110
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Country | US
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Telephone | 704-384-1246
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Fax | 704-384-6072
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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 | 704-384-1246
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Fax | 704-384-6072
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Authorized Official
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Title or Position | EDI 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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry 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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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