Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health University City Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
8401 MEDICAL PLAZA DR, SUITE 250, CHARLOTTE, NC 28262-8700
(704) 384-1500
(704) 384-1525
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1500
(704) 384-1525
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NC
207R00000X
Internal Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011JA
BCBS NC
NC
05
—
89011JA
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
05
—
NPA915
—
SC
Enumeration date
06/16/2006
Last updated
07/09/2024
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