Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Northlake Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
9604 HOLLY POINT DR, HUNTERSVILLE, NC 28078-4913
(704) 316-5070
(704) 316-5075
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-5070
(704) 316-5075
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0900X
Dermatopathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018GV
BCBS
NC
05
—
5904331
—
NC
05
—
NPB181
—
SC
Enumeration date
07/31/2006
Last updated
06/19/2024
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