# NOVANT MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southeast Children's Urology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699095331
- **Authorized official:** MR. GEOFFREY GARDNER (VP OF FINANCE)
- **Authorized official phone:** (704) 384-9094

## Contact information

- **Practice address:** 1401 MATTHEWS TOWNSHIP PKWY, SUITE 312, MATTHEWS, NC 28105-5402
- **Practice address phone:** (704) 384-9530
- **Practice address fax:** (704) 384-9535
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 384-7840
- **Mailing address fax:** (704) 384-7830

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |
| 2088P0231X | Pediatric Urology Physician | — | NULL | Yes |
| 2088P0231X | Pediatric Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/04/2010
- **Last updated:** 06/04/2010