# NOVANT HEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Cotswold Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740236702
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 200 GREENWICH RD, CHARLOTTE, NC 28211-2316
- **Practice address phone:** (704) 384-8680
- **Practice address fax:** (704) 384-8684
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 384-7603
- **Mailing address fax:** (704) 417-4479

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NC | Yes |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 07/09/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0271V | BCBS-NC | NC |
| 05 | — | 890271V | — | NC |
| 01 | — | CC5118 | RAILROAD MEDICARE | NC |