Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Parent organization
NOVANT HEALTH MEDICAL GROUP, LLC
Other names
Novant Health Psychiatric Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Authorized official
LEEA JEANINE WALTON (EDI MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
1900 RANDOLPH ROAD, SUITE 800, CHARLOTTE, NC 28207-1110
(704) 384-1246
(704) 384-6072
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1246
(704) 384-6072
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015Y5
BCBS NC
NC
05
—
6006145 (LCSWS ONLY)
—
NC
05
—
89015Y5
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
05
—
NPB139
—
SC
Enumeration date
05/25/2006
Last updated
06/20/2024
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