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NPI Code Detail

MEDICARE: NOVANT HEALTH MEDICAL GROUP, LLC

MEDICARE: NOVANT HEALTH MEDICAL GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1114327129
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOVANT HEALTH MEDICAL GROUP, LLC
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 704-316-3136
Fax Number : 704-316-3140
Provider Business Practice Location Address
First Line : 7804 FAIRVIEW RD STE A
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-4999
Country : US
Telephone Number : 704-316-3136
Fax Number :
Authorized Official
Title or Position : RCS MANAGER
Name : LEEA JEANINE WALTON
Credential :
Telephone Number : 704-316-6081
Provider Enumeration Date : 08/27/2014
Last Update Date : 07/09/2024

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Directions to “NOVANT HEALTH MEDICAL GROUP, LLC ” Practice Location

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