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
1	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	019J7	OTHER	NC	BCBS NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265622377
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	:	704-316-5000
Fax Number	:	704-316-5010

Provider Business Practice Location Address
First Line	:	14135 BALLANTYNE CORPORATE PL STE 160
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-4221
Country	:	US
Telephone Number	:	704-316-5000
Fax Number	:	704-316-5010

Authorized Official
Title or Position	:	RCS MANAGER
Name	:	LEEA JEANINE WALTON
Credential	:
Telephone Number	:	704-316-6081

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	06/19/2024

Similar Medicare Providers

1972160885 — DR. ALI MASIH BAHER DO
Practice Location Address:

14135 BALLANTYNE CORPORATE PL STE 160
CHARLOTTE, NC
28277-4221

Practice Phone: 704-316-5000
Practice Fax:

1205294568 — MRS. LINDSAY ANN VANG FNP
Practice Location Address:

14135 BALLANTYNE CORPORATE PL STE 160
CHARLOTTE, NC
28277-4221

Practice Phone: 704-316-5000
Practice Fax: 704-316-5010

1982189460 — ERICA LORRINE SEGERS NP
Practice Location Address:

14135 BALLANTYNE CORPORATE PL STE 160
CHARLOTTE, NC
28277-4221

Practice Phone: 704-316-5000
Practice Fax: 704-316-5010

1366423964 — MRS. ANTOINETTE OHLSON PT
Practice Location Address:

4221 TUCKASEEGEE RD
CHARLOTTE, NC
28208-2801

Practice Phone: 704-392-4057
Practice Fax: 704-392-4788

1700867306 — MR. DAVID F NOTA PT
Practice Location Address:

4221 TUCKASEEGEE RD
CHARLOTTE, NC
28208-2801

Practice Phone: 704-392-4057
Practice Fax: 704-822-3189

1114909025 — MRS. SHARLENE V CHILDS OTRL
Practice Location Address:

4221 TUCKASEEGEE RD
CHARLOTTE, NC
28208-2801

Practice Phone: 704-392-4057
Practice Fax: 704-392-4788

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

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.