# NOVANT HEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Child and Adolescent Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386019891
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 3614 PROVIDENCE RD S, SUITE 101, WAXHAW, NC 28173-6309
- **Practice address phone:** (704) 384-8460
- **Practice address fax:** (704) 384-8465
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 384-7840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/09/2015
- **Last updated:** 06/20/2024