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Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Lakeside 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
19485 OLD JETTON RD STE 100, CORNELIUS, NC 28031-6583
(704) 384-1775
(704) 384-1776
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1775
(704) 384-1776
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
NC
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0215V
BCBS-NC
NC
05
—
5903870
—
NC
Enumeration date
05/19/2006
Last updated
03/30/2026
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