Organization
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Active
Other names
Novant Health Pediatric Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (RCS MANAGER)
(704) 303-7517
Entity
Organization
Contact information
Practice address
2131 S 17TH ST, WILMINGTON, NC 28401-7407
(910) 667-5830
(910) 662-8909
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
—
—
Other
Enumeration date
12/20/2021
Last updated
12/20/2021
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