Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Dermatology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
1450 MATTHEWS TOWNSHIP PKWY STE 355, MATTHEWS, NC 28105-4300
(704) 384-6020
(704) 384-6025
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-6020
(704) 384-6025
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5906187
—
NC
01
—
71098
BCBS NC
NC
01
—
CC5118
RAILROAD MEDICARE
NC
05
—
NPB227
—
SC
Enumeration date
06/14/2006
Last updated
09/12/2025
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