Provider Demographics
NPI:1679739304
Name:NOVANT MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NOVANT MEDICAL GROUP INC
Other - Org Name:NOVANT HEALTH FRANKLINTON MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-494-9949
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:919-494-9949
Mailing Address - Fax:919-494-2360
Practice Address - Street 1:3320 US 1 HIGHWAY
Practice Address - Street 2:SUITE D
Practice Address - City:FRANKLINTON
Practice Address - State:NC
Practice Address - Zip Code:27525-8438
Practice Address - Country:US
Practice Address - Phone:919-494-9949
Practice Address - Fax:919-494-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912530Medicaid
NCCC5118OtherRAILROAD MEDICARE
NCCC5118OtherRAILROAD MEDICARE