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General NPI Number Information
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NPI Number | 1639479355
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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 | 10/28/2010
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Last Update Date | 07/05/2013
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Provider Practice Location Address
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Address Line | 1995 WELLNESS BLVD BLDG B SUITE 110
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City | MONROE
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State | NC
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Zip | 28110-7772
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Country | US
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Telephone | 704-316-3030
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Fax | 704-316-3025
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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 | 704-316-3030
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Fax | 704-316-3025
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Authorized Official
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Title or Position | VP FINANCE
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Name | MR. GEOFFREY GARDNER
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Credential |
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Telephone | 704-316-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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