Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Neurology and Sleep
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (EDI MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
3330 SISKEY PKWY, MATTHEWS, NC 28105-3222
(704) 316-9001
(704) 316-9008
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-9001
(704) 384-9440
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017YG
BCBS NC
NC
05
—
5903547
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
05
—
NPB172
—
SC
Enumeration date
05/17/2006
Last updated
06/12/2024
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