Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Child and Adolescent Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
3614 PROVIDENCE RD S, SUITE 101, WAXHAW, NC 28173-6309
(704) 384-8460
(704) 384-8465
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
12/09/2015
Last updated
06/20/2024
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