Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Family Medicine Pine Forest
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
2950 PINE FOREST PARKWAY, SUITE 201, BOLIVIA, NC 28422-6800
(910) 454-4032
(910) 754-4580
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(910) 454-4032
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043564891
—
NC
Enumeration date
11/01/2012
Last updated
07/09/2024
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