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General NPI Number Information
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NPI Number | 1760308449
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Entity Type | Organization
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Legal Business Name | NOVANT HEALTH MEDICAL GROUP NC COASTAL REGION SPECIALTY, LLC
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Dates
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Enumeration Date | 06/26/2026
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Last Update Date | 06/26/2026
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Provider Practice Location Address
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Address Line | 2739 IRON GATE DR
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City | WILMINGTON
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State | NC
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Zip | 28412-3731
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Country | US
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Telephone | 910-763-7363
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Fax |
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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 |
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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 JEANINE WALTON
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Credential |
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Telephone | 336-515-7085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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