# NOVANT HEALTH MEDICAL GROUP, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NOVANT MEDICAL GROUP, INC
- **Other names:** Novant Health Primary Care Partners
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1235458985
- **Legal business name:** NOVANT MEDICAL GROUP, INC
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 10500 LIGON MILL RD, SUITE 113, WAKE FOREST, NC 27587-4576
- **Practice address phone:** (919) 570-5705
- **Practice address fax:** (919) 570-5710
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (919) 570-5705
- **Mailing address fax:** (919) 570-5710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2005-01578 | NC | Yes |

## Other

- **Enumeration date:** 05/20/2010
- **Last updated:** 07/09/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5914970 | — | NC |