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General NPI Number Information
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NPI Number | 1831079573
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Entity Type | Organization
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Legal Business Name | NOVANT HEALTH GREENVILLE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 701 CONGAREE RD
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City | GREENVILLE
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State | SC
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Zip | 29607-3519
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Country | US
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Telephone | 864-248-4130
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Fax | 864-248-4131
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Provider Business Mailing Address
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Address Line | PO BOX 604348
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City | CHARLOTTE
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State | NC
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Zip | 28260-4348
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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 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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number |
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License Number State |
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