Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Lakeside 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
19485 OLD JETTON RD STE 100, CORNELIUS, NC 28031-6583
(704) 384-1775
(704) 384-1776
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1775
(704) 384-1776
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
NC
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0215V
BCBS-NC
NC
05
—
5903870
—
NC
Enumeration date
05/19/2006
Last updated
03/30/2026
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