Organization
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Active
Other names
NHMGCR UNC Children's
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (RCS MANAGER)
(704) 303-7517
Entity
Organization
Contact information
Practice address
2131 S 17TH ST, WILMINGTON, NC 28401-7407
(910) 667-4620
(910) 667-4639
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
(910) 667-4620
(910) 667-4639
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
04/08/2021
Last updated
09/02/2021
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