Organization
NOVANT MEDICAL GROUP INC
Active
Other names
Novant Health Perry Medders Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY GARDNER (VP OF FINANCE)
(919) 496-4250
Entity
Organization
Contact information
Practice address
205 SANDALWOOD AVE, SUITE A, LOUISBURG, NC 27549-2679
(919) 496-4250
(919) 496-1515
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(919) 496-4250
(919) 496-1515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5911436
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
Enumeration date
07/14/2008
Last updated
11/29/2013
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