# NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Sports Primary Care at UNCW
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255267423
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 720 HAMILTON DR, WILMINGTON, NC 28403
- **Practice address phone:** (910) 763-5522
- **Practice address fax:** (910) 763-0413
- **Mailing address:** PO BOX 936857, ATLANTA, GA 31193-6857

## Taxonomy

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

## Other

- **Enumeration date:** 06/23/2026
- **Last updated:** 06/23/2026