Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Ocean Isle Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY GARDNER (VP OF OPERATIONS)
(704) 384-9094
Entity
Organization
Contact information
Practice address
120 CAUSEWAY DR, SUITE 4, OCEAN ISLE BEACH, NC 28469-7538
(910) 575-5242
(910) 575-5245
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 384-7840
(910) 575-5245
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019T3
BCBS OF NC
NC
05
—
5908211
—
NC
01
—
DG7127
RAILROAD MEDICARE
NC
Enumeration date
07/27/2007
Last updated
07/19/2011
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