# NOVANT HEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Pediatric Allergy & Immunology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447877931
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 6331 CARMEL RD STE 102, CHARLOTTE, NC 28226-8286
- **Practice address phone:** (704) 316-9022
- **Practice address fax:** (704) 316-9026
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080P0201X | Pediatric Allergy/Immunology Physician | — | NULL | Yes |
| 2080P0201X | Pediatric Allergy/Immunology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/30/2020
- **Last updated:** 06/20/2024