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General NPI Number Information
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NPI Number | 1780879544
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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 | 09/13/2007
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 4503 MAIN STREET
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City | SHALLOTTE
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State | NC
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Zip | 28470-4447
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Country | US
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Telephone | 910-755-5440
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Fax | 910-755-5420
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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 | 704-384-9094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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