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Organization
NOVANT MEDICAL GROUP, INC.
Active
Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Southeast Children's Urology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEOFFREY GARDNER (VP OF FINANCE)
(704) 384-9094
Entity
Organization
Contact information
Practice address
1401 MATTHEWS TOWNSHIP PKWY, SUITE 312, MATTHEWS, NC 28105-5402
(704) 384-9530
(704) 384-9535
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
—
NULL
208800000X
Urology Physician
—
—
2088P0231X
Pediatric Urology Physician
Primary
—
NULL
2088P0231X
Pediatric Urology Physician
Primary
—
—
Other
Enumeration date
06/04/2010
Last updated
06/04/2010
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