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NPI Code Detail

MEDICARE: NOVANT MEDICAL GROUP, INC.

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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1922627645
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOVANT MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2845 BEATTIES FORD RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28216-3711
Country : US
Telephone Number : 980-302-9304
Fax Number :
Authorized Official
Title or Position : RCS MANAGER
Name : SHALA DAVIS
Credential :
Telephone Number : 704-316-7845
Provider Enumeration Date : 04/13/2020
Last Update Date : 12/08/2020

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