Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Medical Plaza Family Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFERRY GARDNER (VP OF OPERATIONS)
(704) 384-9094
Entity
Organization
Contact information
Practice address
8401 MEDICAL PLAZA DR, SUITE 300, CHARLOTTE, NC 28262-8797
(704) 316-1800
(704) 316-1773
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011CE
BCBS-NC
NC
05
—
89011CE
—
NC
01
—
CG8887
RAILROAD MEDICARE
NC
05
—
NPA880
—
SC
Enumeration date
06/15/2006
Last updated
07/19/2011
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