# NOVANT MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NOVANT MEDICAL GROUP, INC
- **Other names:** Novant Health Granite Quarry Internal Medicine & Pediatrics
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104152024
- **Legal business name:** NOVANT MEDICAL GROUP, INC
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 111 S SALISBURY GQ AVE, SALISBURY, NC 28146-8150
- **Practice address phone:** (704) 279-1679
- **Practice address fax:** (704) 279-1677
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 279-1679
- **Mailing address fax:** (704) 279-1677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NC | — |

## Other

- **Enumeration date:** 10/28/2009
- **Last updated:** 07/10/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5913612 | — | NC |