Organization
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Active
Other names
Novant Health Ventricular Assistance
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (ENROLLMENT MANAGER)
(704) 303-7517
Entity
Organization
Contact information
Practice address
2131 S 17TH ST, WILMINGTON, NC 28401-7407
(910) 667-5105
(910) 667-5109
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
(910) 667-5105
(910) 667-5109
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Enumeration date
05/10/2022
Last updated
05/10/2022
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