# NOVANT HEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Blakeney Family Physicians
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043340557
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 5815 BLAKENEY PARK DR STE 200B, CHARLOTTE, NC 28277-5734
- **Practice address phone:** (704) 316-5080
- **Practice address fax:** (704) 316-5085
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 316-5080
- **Mailing address fax:** (704) 316-5085

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NC | Yes |

## Other

- **Enumeration date:** 03/06/2007
- **Last updated:** 07/09/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 019C1 | BCBS-NC | NC |
| 05 | — | 5906264 | — | NC |