Organization
NOVA IC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY PRIDGEN CPA (CFO)
(919) 734-8803
Entity
Organization
Contact information
Practice address
2307 NORWOOD AVE STE A, GOLDSBORO, NC 27534-1601
(919) 735-8887
(919) 735-8871
Mailing address
PO BOX 11077, GOLDSBORO, NC 27532-1077
(919) 734-8803
(919) 735-6825
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406058
—
NC
05
—
340608V
—
NC
05
—
340609R
—
NC
05
—
340610M
—
NC
05
—
3406164
—
NC
05
—
3406174
—
NC
05
—
3406289
—
NC
05
—
3406312
—
NC
05
—
6006439
—
NC
05
—
8302565
—
NC
05
—
8302772
—
NC
Enumeration date
03/09/2010
Last updated
10/08/2025
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