Organization
NOVANT MEDICAL GROUP, INC.
Active
Other names
Novant Health Northlake Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (ENROLLMENT MANAGER)
(704) 316-7845
Entity
Organization
Contact information
Practice address
6324 FAIRVIEW RD # 200, CHARLOTTE, NC 28210-3271
(704) 316-5070
(704) 316-5075
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-5070
(704) 316-5075
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
02/04/2020
Last updated
02/04/2020
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