Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Urgent Care Shallotte
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY GARDNER (VP OF OPERATIONS)
(704) 384-9094
Entity
Organization
Contact information
Practice address
4503 MAIN STREET, SHALLOTTE, NC 28470-4447
(910) 755-5440
(910) 755-5420
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020C5
BCBS-NC
NC
05
—
5909127
—
NC
Enumeration date
09/13/2007
Last updated
07/19/2011
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