# NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Coastal Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538749148
- **Authorized official:** SHALA DAVIS (RCS MANAGER)
- **Authorized official phone:** (704) 303-7517

## Contact information

- **Practice address:** 2523 DELANEY AVE, WILMINGTON, NC 28403-6003
- **Practice address phone:** (910) 763-5522
- **Mailing address:** PO BOX 936857, ATLANTA, GA 31193-6857

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/09/2021
- **Last updated:** 07/19/2021