# NOVANT HEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Bradford Clinic Obstetrics & Gynecology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225094204
- **Authorized official:** LEEA JEANINE WALTON (EDI MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 325 HAWTHORNE LN, SUITE 200, CHARLOTTE, NC 28204-2433
- **Practice address phone:** (704) 973-2106
- **Practice address fax:** (704) 973-2395
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 973-2106
- **Mailing address fax:** (704) 973-2395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NC | Yes |

## Other

- **Enumeration date:** 04/26/2006
- **Last updated:** 06/20/2024