# NOVANT HEALTH MEDICAL GROUP, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Colon & Rectal Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366781445
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 7210 VILLAGE MEDICAL CIR STE 310, CLEMMONS, NC 27012-8041
- **Practice address phone:** (336) 277-4075
- **Practice address fax:** (336) 277-4070
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (336) 277-4075
- **Mailing address fax:** (336) 277-4070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208C00000X | Colon & Rectal Surgery Physician | — | NULL | Yes |
| 208C00000X | Colon & Rectal Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/08/2013
- **Last updated:** 03/20/2025