Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Huntersville Pediatrics & Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
16525 HOLLY CREST LN STE 150, HUNTERSVILLE, NC 28078-4911
(704) 384-8720
(704) 384-8747
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0107L
BCBS
NC
05
—
890107L
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
Enumeration date
05/18/2006
Last updated
06/20/2024
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