Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Heatlh Inpatient Pediatric Specialitsts
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
200 HAWTHORNE LN, CHARLOTTE, NC 28204-2515
(704) 384-4021
(704) 384-5601
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-4021
(704) 384-5601
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018KF
BCBS NC
NC
05
—
5905265
—
NC
05
—
NPB189
—
SC
Enumeration date
09/19/2006
Last updated
06/24/2024
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