Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Family & Internal Medicine South Brunswick
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
75 EMERSON BAY STREET SW, SUITE 102, CAROLINA SHORES, NC 28467-2498
(910) 579-8363
(910) 579-8306
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(910) 579-8363
(910) 579-8306
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950530
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
Enumeration date
09/23/2008
Last updated
07/09/2024
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