Provider Demographics
NPI: | 1326686890 |
---|---|
Name: | NOVANT MEDICAL GROUP, INC. |
Entity Type: | Organization |
Organization Name: | NOVANT MEDICAL GROUP, INC. |
Other - Org Name: | NOVANT HEALTH WOMEN'S SEXUAL HEALTH & WELLNESS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | RCS MANAGER |
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: | 704-303-7517 |
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: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6324 FAIRVIEW RD STE 440 |
Practice Address - Street 2: | |
Practice Address - City: | CHARLOTTE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28210-4278 |
Practice Address - Country: | US |
Practice Address - Phone: | 980-302-8945 |
Practice Address - Fax: | 980-302-8980 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-12-16 |
Last Update Date: | 2021-08-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |