# NOVANT MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Maternal-Fetal Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770839458
- **Authorized official:** SHALA DAVIS (RCS MANAGER)
- **Authorized official phone:** (704) 303-7517

## Contact information

- **Practice address:** 19475 OLD JETTON RD, CORNELIUS, NC 28031-6591
- **Practice address phone:** (704) 384-5701
- **Practice address fax:** (704) 384-5642
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 384-5701
- **Mailing address fax:** (704) 384-5642

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | NULL | Yes |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/31/2012
- **Last updated:** 08/16/2021