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General NPI Number Information
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NPI Number | 1972168508
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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 | 05/09/2019
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 19485 OLD JETTON RD STE 270
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City | CORNELIUS
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State | NC
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Zip | 28031-6592
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Country | US
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Telephone | 704-384-7680
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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 | ENROLLMENT MANAGER
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Name | SHALA DAVIS
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Credential |
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Telephone | 704-316-7845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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