Provider Demographics
NPI:1093292997
Name:NOVANT MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:NOVANT MEDICAL GROUP INC.
Other - Org Name:NOVANT HEALTH TRIAD ENDOCRINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF MANAGED CARE ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHALA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-316-7845
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-992-1351
Mailing Address - Fax:336-992-1361
Practice Address - Street 1:6316 OLD OAK RIDGE RD STE E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9940
Practice Address - Country:US
Practice Address - Phone:336-992-1351
Practice Address - Fax:336-992-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty