# NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Cancer Institute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790569655
- **Authorized official:** LEEA JEANINE WALTON (MANAGER)
- **Authorized official phone:** (336) 515-7085

## Contact information

- **Practice address:** 2131 S 17TH ST, WILMINGTON, NC 28401-7407
- **Practice address phone:** (910) 667-3000
- **Practice address fax:** (910) 338-0965
- **Mailing address:** PO BOX 936857, ATLANTA, GA 31193-6857
- **Mailing address phone:** (910) 667-3000
- **Mailing address fax:** (910) 338-0965

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 170300000X | Genetic Counselor (M.S.) | — | NULL | Yes |
| 170300000X | Genetic Counselor (M.S.) | — | — | Yes |

## Other

- **Enumeration date:** 08/22/2023
- **Last updated:** 08/22/2023