Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Gilead Road Pediatrics & Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
9615 KINCEY AVENUE, SUITE 100, HUNTERSVILLE, NC 28078-9140
(704) 316-5635
(704) 316-5640
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 316-5640
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NC
208000000X
Pediatrics Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017F5
BCBS-NC
NC
05
—
5902021
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
Enumeration date
05/16/2006
Last updated
06/20/2024
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