Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Triad Obstetrics & Gynecology
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
2909 MAPLEWOOD AVENUE, WINSTON SALEM, NC 27103
(336) 277-0340
(336) 277-0359
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 277-0340
(336) 277-0359
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083986111
—
NC
01
—
5919510
FORMER NC MEDICAID NUMBER
NC
Enumeration date
02/06/2012
Last updated
06/21/2024
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