Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Health Maternal and Fetal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (RCS MANAGER)
(704) 303-7517
Entity
Organization
Contact information
Practice address
1718 E 4TH ST, SUITE 404, CHARLOTTE, NC 28204-3193
(704) 384-5701
(704) 384-5642
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7680
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017YP
BCBS NC
NC
05
—
5903442
—
NC
05
—
NPB169
—
SC
Enumeration date
05/05/2006
Last updated
08/16/2021
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