# NOVANT HEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902693542
- **Authorized official:** LEEA JEANINE WALTON (MANAGER)
- **Authorized official phone:** (336) 515-7085

## Contact information

- **Practice address:** 400 AVINGER LN, DAVIDSON, NC 28036-8800
- **Practice address phone:** (336) 481-8655
- **Practice address fax:** (336) 277-9165
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 04/24/2025
- **Last updated:** 06/04/2025