Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Health Fort Mill 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
1690 HIGHWAY 160 W, FORT MILL, SC 29708-8024
(803) 547-7541
(803) 548-0122
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4288
—
SC
Enumeration date
04/06/2006
Last updated
06/27/2013
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