Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Indian Land Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (RCS MANAGER)
(704) 303-7517
Entity
Organization
Contact information
Practice address
8500 CHARLOTTE HWY, INDIAN LAND, SC 29707-7591
(803) 548-9393
(803) 548-9590
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4510
—
SC
Enumeration date
09/13/2006
Last updated
04/29/2026
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