Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Health Pine Lake Family Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFERY K GARDNER (VP OF FINANCE)
(704) 384-7606
Entity
Organization
Contact information
Practice address
4105 MATTHEWS MINT HILL RD, MINT HILL, NC 28105-3633
(704) 384-9920
(704) 384-9925
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-9920
(704) 384-9925
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
790209N
—
NC
05
—
NPA894
—
SC
Enumeration date
08/01/2005
Last updated
07/26/2013
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