# 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 Surry Medical Extended Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659950053
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 2133 ROCKFORD ST STE 1400, MOUNT AIRY, NC 27030-6594
- **Practice address phone:** (336) 673-6560
- **Practice address fax:** (336) 719-0494
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 04/05/2021
- **Last updated:** 07/09/2024