MEDICARE: NOVANT MEDICAL GROUP, INC.

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
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DG7127	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	019T3	OTHER	NC	BCBS OF NC

General Provider Information

NPI Number	:	1144410937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVANT MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 602362
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2362
Country	:	US
Telephone Number	:	704-384-7840
Fax Number	:	910-575-5245

Provider Business Practice Location Address
First Line	:	120 CAUSEWAY DR
Second Line	:	SUITE 4
City	:	OCEAN ISLE BEACH
State	:	NC
Zip	:	28469-7538
Country	:	US
Telephone Number	:	910-575-5242
Fax Number	:	910-575-5245

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	GEOFFREY GARDNER
Credential	:
Telephone Number	:	704-384-9094

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	07/19/2011

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Directions to “NOVANT MEDICAL GROUP, INC. ” Practice Location

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