Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Health Osteopathic and Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY K. GARDNER (VP OF FINANCE)
(704) 384-9144
Entity
Organization
Contact information
Practice address
8420 UNIVERSITY EXEC PARK DR, SUITE 850, CHARLOTTE, NC 28262-1344
(704) 316-1750
(704) 316-1755
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0109P
BCBS-NC
NC
05
—
89015FJ
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
Enumeration date
06/06/2006
Last updated
11/22/2017
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