# NOVANT HEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Lakeside Primary Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093976474
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 5325 VINNING ST NW, SUITE 101, CONCORD, NC 28027-2956
- **Practice address phone:** (704) 316-1040
- **Practice address fax:** (704) 316-1041
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 316-1040
- **Mailing address fax:** (704) 316-1041

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NC | Yes |
| 207R00000X | Internal Medicine Physician | — | NC | — |

## Other

- **Enumeration date:** 06/19/2008
- **Last updated:** 07/09/2024