Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Pulmonary and Critical Care
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
1918 RANDOLPH RD STE 580, CHARLOTTE, NC 28207-1116
(704) 384-9900
(704) 384-9919
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-9200
(704) 384-6588
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101Q
BCBS
NC
05
—
890101Q
—
NC
01
—
CG8889
RAILROAD MEDICARE
NC
05
—
NPA892
—
NC
Enumeration date
04/07/2006
Last updated
06/14/2024
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