Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
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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