# NOVANT HEALTH MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1265074595
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 652 E MONMOUTH ST, WINSTON SALEM, NC 27107-3227
- **Practice address phone:** (336) 718-4390
- **Practice address fax:** (336) 718-4399
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447

## Taxonomy

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

## Other

- **Enumeration date:** 10/08/2019
- **Last updated:** 07/08/2024