Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Pediatric Neurology & Sleep
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
1900 RANDOLPH RD STE 1010, CHARLOTTE, NC 28207-1117
(704) 384-1390
(704) 384-1063
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1390
(704) 384-1063
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
—
NC
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
—
—
2084N0600X
Clinical Neurophysiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017U7
BCBS NC
NC
05
—
5902989
—
NC
05
—
NPB151
—
SC
Enumeration date
05/01/2006
Last updated
06/14/2024
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