# NOVANT MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NOVANT MEDICAL GROUP, INC.
- **Other names:** Novant Health Pediatric Rehabilitation
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396366316
- **Legal business name:** NOVANT MEDICAL GROUP, INC.
- **Authorized official:** SHALA DAVIS (RCS MANAGER)
- **Authorized official phone:** (704) 303-7517

## Contact information

- **Practice address:** 2711 RANDOLPH RD STE 100, CHARLOTTE, NC 28207-2027
- **Practice address phone:** (980) 302-8271
- **Practice address fax:** (980) 302-8285
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | — | NULL | Yes |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/30/2020
- **Last updated:** 08/16/2021