# NOVANT HEALTH MEDICAL GROUP, 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:** Novant Health Pediatric Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639695133
- **Authorized official:** LEEA JEANINE WALTON (EDI MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 201 QUEENS RD, CHARLOTTE, NC 28204
- **Practice address phone:** (704) 316-1070
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080S0010X | Pediatric Sports Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/16/2017
- **Last updated:** 07/11/2024