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Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Blakeney Family Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
5815 BLAKENEY PARK DR STE 200B, CHARLOTTE, NC 28277-5734
(704) 316-5080
(704) 316-5085
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-5080
(704) 316-5085
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019C1
BCBS-NC
NC
05
—
5906264
—
NC
Enumeration date
03/06/2007
Last updated
07/09/2024
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