Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RSC MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
1918 RANDOLPH RD STE 700, CHARLOTTE, NC 28207-1167
(980) 488-9630
(980) 488-9635
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0120X
Pediatric Surgery Physician
—
—
Other
Enumeration date
09/11/2024
Last updated
10/14/2024
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