Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Northgate 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
1028 LEE ANN DR NE, SUITE 100, CONCORD, NC 28025-2903
(704) 788-1134
(704) 788-1186
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018WE
BCBS NC
NC
05
—
5906102
—
NC
Enumeration date
02/06/2007
Last updated
07/19/2011
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