Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Ballantyne Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
15825 BALLANTYNE MEDICAL PLACE, SUITE 200, CHARLOTTE, NC 28277-3147
(704) 384-1925
(704) 384-1930
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1925
(704) 384-1930
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014VG
BCBS
NC
05
—
89014VG
—
NC
01
—
CC5118
RR MEDICARE
NC
Enumeration date
08/12/2005
Last updated
07/09/2024
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