# NOVANT MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Colon and Rectal Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619389202
- **Authorized official:** GEOFFREY K. GARDNER (VP OF FINANCE)
- **Authorized official phone:** (336) 765-5221

## Contact information

- **Practice address:** 7126 VILLAGE MEDICAL CIR, CLEMMONS, NC 27012-8004
- **Practice address phone:** (336) 765-5221
- **Practice address fax:** (336) 765-0430
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 384-7840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208C00000X | Colon & Rectal Surgery Physician | — | NULL | Yes |
| 208C00000X | Colon & Rectal Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/30/2014
- **Last updated:** 03/11/2015