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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
12084S0012XSleep Medicine (Psychiatry & Neurology) PhysicianNC
22084N0400XNeurology PhysicianNC

General Provider Information

NPI Number : 1285882688
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 : 704-316-5388
Fax Number : 704-316-1848
Provider Business Practice Location Address
First Line : 10305 HAMPTONS PARK DR STE 101
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-7221
Country : US
Telephone Number : 704-316-5388
Fax Number : 704-316-1848
Authorized Official
Title or Position : RCS MANAGER
Name : LEEA JEANINE WALTON
Credential :
Telephone Number : 704-316-6081
Provider Enumeration Date : 08/28/2008
Last Update Date : 06/12/2024

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Practice Location Address:
10305 HAMPTONS PARK DR STE 101
HUNTERSVILLE, NC
28078-7221
Practice Phone: 704-384-7680
Practice Fax:
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1811100142 — PETERSON FORTUNATO GIALLANZA M.D.
Practice Location Address:
10305 HAMPTONS PARK DR STE 101
HUNTERSVILLE, NC
28078-7221
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Practice Fax: 704-316-1848
1104222785 — ANSLEY WALKER BOUTIN PT
Practice Location Address:
10305 HAMPTONS PARK DR STE 101
HUNTERSVILLE, NC
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1114475605 — GRETCHEN DIANE JOPP PA-C
Practice Location Address:
10305 HAMPTONS PARK DR STE 101
HUNTERSVILLE, NC
28078-7221
Practice Phone: 704-316-3070
Practice Fax: 704-316-3071

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

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