Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Pineville Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
10514 PARK RD, CHARLOTTE, NC 28210-8405
(704) 384-9960
(704) 384-9965
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-9960
(704) 384-9965
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0209T
BCBS NC
NC
05
—
890209T
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
05
—
NPA883
—
SC
Enumeration date
06/14/2006
Last updated
07/09/2024
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