Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Pediatric Gastroenterology
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (EDI MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
1918 RANDOLPH RD STE 210, CHARLOTTE, NC 28207-1109
(704) 316-5060
(704) 316-5069
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-5060
(704) 316-5069
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018WH
BCBS NC
NC
05
—
5905866
—
NC
05
—
NPB219
—
SC
Enumeration date
01/11/2007
Last updated
07/31/2025
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