Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Lakeside 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
13460 PLAZA ROAD EXT STE 100, CHARLOTTE, NC 28215-8923
(704) 316-4990
(704) 316-4998
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7603
(704) 417-4479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5921588
—
NC
Enumeration date
05/15/2012
Last updated
07/09/2024
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