Organization
NOVANT MEDICAL GROUP, INC.
Active
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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