# NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NHMGCR Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922767243
- **Authorized official:** SHALA DAVIS (RCS MANAGER)
- **Authorized official phone:** (704) 303-7517

## Contact information

- **Practice address:** 2000 BRABHAM AVE, JACKSONVILLE, NC 28546-0201
- **Practice address phone:** (910) 376-3025
- **Practice address fax:** (910) 362-9123
- **Mailing address:** PO BOX 936857, ATLANTA, GA 31193-6857

## Taxonomy

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

## Other

- **Enumeration date:** 12/14/2021
- **Last updated:** 12/14/2021