Organization
NOVANT MEDICAL GROUP, INC
Active
Other names
Novant Health Psychiatric Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY K GARDNER (VP OF FINANCE)
(704) 384-9094
Entity
Organization
Contact information
Practice address
175 KIMEL PARK DR, SUITE 100, WINSTON SALEM, NC 27103-6951
(336) 277-1800
(336) 277-9538
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5917753
—
NC
Enumeration date
05/20/2011
Last updated
06/21/2013
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