Organization
NMG AFFILIATE PRACTICE I, LLC
Active
Other names
Novant Health UVA Health System Olde Towne Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (MANAGER)
(704) 316-7845
Entity
Organization
Contact information
Practice address
8180 STONEWALL SHOPS SQ, GAINESVILLE, VA 20155-3891
(703) 365-0227
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(844) 266-8268
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
11/14/2018
Last updated
11/14/2018
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