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Organization
NOVANT MEDICAL GROUP, INC.
Active
Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Medical Plaza Family Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFERRY GARDNER (VP OF OPERATIONS)
(704) 384-9094
Entity
Organization
Contact information
Practice address
8401 MEDICAL PLAZA DR, SUITE 300, CHARLOTTE, NC 28262-8797
(704) 316-1800
(704) 316-1773
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011CE
BCBS-NC
NC
05
—
89011CE
—
NC
01
—
CG8887
RAILROAD MEDICARE
NC
05
—
NPA880
—
SC
Enumeration date
06/15/2006
Last updated
07/19/2011
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