Organization
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Active
Other names
Novant Health Michael Jordan Family Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (ENROLLMENT MANAGER)
(336) 515-7085
Entity
Organization
Contact information
Practice address
1423 GREENFIELD ST, WILMINGTON, NC 28401
(910) 662-0761
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
(910) 833-9100
(910) 833-9109
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/26/2023
Last updated
11/16/2023
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