Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Bradford Clinic Obstetrics & Gynecology
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (EDI MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
325 HAWTHORNE LN, SUITE 200, CHARLOTTE, NC 28204-2433
(704) 973-2106
(704) 973-2395
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 973-2106
(704) 973-2395
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0270T
BCBS-NC
NC
05
—
1225094204
—
NC
05
—
5901191
—
NC
Enumeration date
04/26/2006
Last updated
06/20/2024
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