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Organization
NOVANT MEDICAL GROUP, INC.
Active
Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Health Gynecologic Oncology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (RCS MANAGER)
(704) 303-7517
Entity
Organization
Contact information
Practice address
1918 RANDOLPH RD STE 175, CHARLOTTE, NC 28207-1107
(704) 384-8200
(704) 384-8208
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015KR
BCBS NC
NC
05
—
89015KR
—
NC
05
—
NPB048
—
SC
Enumeration date
06/07/2006
Last updated
08/18/2021
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