# NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Michael Jordan Family Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306618053
- **Authorized official:** LEEA JEANINE WALTON (ENROLLMENT MANAGER)
- **Authorized official phone:** (336) 515-7085

## Contact information

- **Practice address:** 1423 GREENFIELD ST, WILMINGTON, NC 28401
- **Practice address phone:** (910) 662-0761
- **Mailing address:** PO BOX 936857, ATLANTA, GA 31193-6857
- **Mailing address phone:** (910) 833-9100
- **Mailing address fax:** (910) 833-9109

## Taxonomy

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

## Other

- **Enumeration date:** 10/26/2023
- **Last updated:** 11/16/2023