Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health University Family Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
10810 MALLARD CREEK RD, CHARLOTTE, NC 28262-9786
(704) 510-8000
(704) 510-8006
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 510-8000
(704) 510-8006
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015H7
BCBS NC
NC
05
—
89015H7
—
NC
01
—
DE6891
RAILROAD MEDICARE
NC
Enumeration date
06/12/2006
Last updated
07/09/2024
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