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Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health University Family Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
10810 MALLARD CREEK RD, CHARLOTTE, NC 28262-9786
(704) 510-8000
(704) 510-8006
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 510-8000
(704) 510-8006
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015H7
BCBS NC
NC
05
—
89015H7
—
NC
01
—
DE6891
RAILROAD MEDICARE
NC
Enumeration date
06/12/2006
Last updated
07/09/2024
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