Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Health University Internal Medicine & Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY GARDNER (VP FINANCE)
(704) 384-9144
Entity
Organization
Contact information
Practice address
10320 MALLARD CREEK RD, SUITE 120, CHARLOTTE, NC 28262-5204
(704) 384-0570
(704) 384-0571
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-0570
(704) 384-0571
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017WR
BCBS
NC
05
—
5903443
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
Enumeration date
07/25/2006
Last updated
11/29/2013
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