Organization
NOVANT MEDICAL GROUP, INC.
Active
Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Health Durham Internal Medicine Associates
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (RCS MGR)
(704) 303-7517
Entity
Organization
Contact information
Practice address
4205 BEN FRANKLIN BLVD, DURHAM, NC 27704-2143
(919) 477-6900
(919) 477-5081
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(919) 477-6900
(919) 477-5081
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019NV
BLUECROSS BLUESHIELD
NC
05
—
5908373
—
NC
01
—
DG6234
RAILROAD MEDICARE
NC
01
—
K414
BLUE MEDICARE
NC
Enumeration date
11/19/2007
Last updated
08/18/2021
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