Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Health Providence OB/GYN
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY K. GARDNER (VP OF FINANCE)
(704) 372-4000
Entity
Organization
Contact information
Practice address
1718 E 4TH ST, SUITE 907, CHARLOTTE, NC 28204-3282
(704) 372-4000
(704) 334-4855
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 372-4000
(704) 334-4855
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011VY
BCBS NC
NC
05
—
5907955
—
NC
05
—
NPB255
—
SC
Enumeration date
03/01/2007
Last updated
07/05/2013
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