Organization
NMG AFFILATE PRACTICE I LLC
Active
Other names
Novant Health Oncology Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEOFFREY KEITH GARDNER (VP FINANCE)
(704) 384-7603
Entity
Organization
Contact information
Practice address
516 S VAN BUREN RD, EDEN, NC 27288-5019
(336) 623-9713
(336) 623-1031
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
207RX0202X
Medical Oncology Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689077539
—
NC
Enumeration date
10/07/2014
Last updated
05/14/2015
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