Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
114 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 765-5470
(336) 765-5428
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 765-5470
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841427200
BCBS NC
NC
05
—
5912104
—
NC
Enumeration date
06/12/2009
Last updated
06/21/2024
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