Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Foot and Ankle
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
3641 WESTGATE CENTER CIR STE A, WINSTON SALEM, NC 27103-2936
(336) 277-6550
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427398023
VIRGINIA MEDICAID
VA
05
—
1427398023
—
NC
Enumeration date
02/20/2013
Last updated
07/23/2024
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