Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Southeast Children's Urology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEOFFREY GARDNER (VP OF FINANCE)
(704) 384-9094
Entity
Organization
Contact information
Practice address
1401 MATTHEWS TOWNSHIP PKWY, SUITE 312, MATTHEWS, NC 28105-5402
(704) 384-9530
(704) 384-9535
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
—
—
2088P0231X
Pediatric Urology Physician
Primary
—
—
Other
Enumeration date
06/04/2010
Last updated
06/04/2010
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