Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Village Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
3213 ROGERS ROAD, WAKE FOREST, NC 27587-3805
(919) 562-2288
(919) 562-2225
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(919) 562-2288
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020E0
BCBS
NC
05
—
5907996
—
NC
Enumeration date
07/18/2007
Last updated
07/09/2024
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