Provider Demographics
NPI:1326894999
Name:NOVANT HEALTH MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:NOVANT HEALTH MEDICAL GROUP, LLC
Other - Org Name:NOVANT HEALTH SPINE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MED CRED COORD LEAD
Authorized Official - Prefix:
Authorized Official - First Name:LEEA
Authorized Official - Middle Name:JEANINE
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-316-6081
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 1:517 ALCOVE RD STE 102
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8574
Practice Address - Country:US
Practice Address - Phone:704-660-4750
Practice Address - Fax:704-660-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty