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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