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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