Organization
NOVANT MEDICAL GROUP INC
Active
Other names
Carolina Coast Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEOFFREY K GARDNER (VP OF FINANCE)
(704) 384-9094
Entity
Organization
Contact information
Practice address
5058 WRIGHTSVILLE AVE, WILMINGTON, NC 28403-7048
(910) 791-5426
(910) 799-2433
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
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950524
—
NC
Enumeration date
06/27/2008
Last updated
04/21/2010
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