Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Child & Adolescent Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
1994 WELLNESS BLVD, SUITE 110, MONROE, NC 28110-7768
(704) 384-8460
(704) 384-8465
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-8460
(704) 384-8465
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017AF
BCBS-NC
NC
05
—
5900603
—
NC
05
—
NPB110
—
SC
Enumeration date
05/20/2006
Last updated
06/20/2024
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