Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Waverly Pediatrics and Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
11840 SOUTHMORE DR, SUITE 200, CHARLOTTE, NC 28277-4466
(704) 384-1166
(704) 384-1181
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1166
(704) 384-1181
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NC
207R00000X
Internal Medicine Physician
—
NC
208000000X
Pediatrics Physician
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016XU
BCBS-NC
NC
05
—
5901214
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
05
—
NPB256
—
SC
Enumeration date
07/10/2006
Last updated
06/21/2024
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