Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Southern Piedmont Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
1995 WELLNESS BLVD STE 110&210, MONROE, NC 28110-7769
(704) 384-1140
(704) 384-1141
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1140
(704) 384-1141
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0138U
BCBS
NC
05
—
890138U
—
NC
05
—
NPA743
—
SC
Enumeration date
06/03/2006
Last updated
07/09/2024
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