Organization
NOVANT MEDICAL GROUP INC
Active
Other names
Pediatric Gastroenterology Associates (satellite)
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY GARDNER (VP FINANCE NMG)
(704) 384-9094
Entity
Organization
Contact information
Practice address
16139 LANCASTER HWY, SUITE 110, CHARLOTTE, NC 28277-2033
(704) 316-5060
(704) 316-5069
Mailing address
P O BOX 60447, NOVANT MEDICAL GROUP, INC., CHARLOTTE, NC 28275-1803
(704) 316-5060
(704) 316-5069
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5919443
—
NC
Enumeration date
09/21/2011
Last updated
09/29/2016
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