# NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Coastal Thoracic Surgical Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497340327
- **Authorized official:** SHALA DAVIS (RCS MANAGER)
- **Authorized official phone:** (704) 303-7517

## Contact information

- **Practice address:** 1912 TRADD CT, WILMINGTON, NC 28401-6637
- **Practice address phone:** (910) 815-5982
- **Mailing address:** PO BOX 936857, ATLANTA, GA 31193-6857

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/03/2021
- **Last updated:** 07/19/2021