Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Health Gynecologic Oncology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (RCS MANAGER)
(704) 303-7517
Entity
Organization
Contact information
Practice address
1918 RANDOLPH RD STE 175, CHARLOTTE, NC 28207-1107
(704) 384-8200
(704) 384-8208
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015KR
BCBS NC
NC
05
—
89015KR
—
NC
05
—
NPB048
—
SC
Enumeration date
06/07/2006
Last updated
08/18/2021
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