# NOVANT HEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Urogynecology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447414925
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 6324 FAIRVIEW RD, STE 390, CHARLOTTE, NC 28210-4173
- **Practice address phone:** (704) 316-1120
- **Practice address fax:** (704) 316-1121
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 316-1120
- **Mailing address fax:** (704) 316-1121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 207VF0040X | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician | — | NULL | — |
| 207VF0040X | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician | — | — | — |

## Other

- **Enumeration date:** 07/15/2008
- **Last updated:** 07/16/2024