Provider Demographics
NPI:1689917783
Name:NOVANT MEDICAL GROUP
Entity Type:Organization
Organization Name:NOVANT MEDICAL GROUP
Other - Org Name:NOVANT HEALTH NUTRITION SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF NMG FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-384-9144
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:336-718-6770
Mailing Address - Fax:336-277-1889
Practice Address - Street 1:5175 OLD CLEMMONS SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9087
Practice Address - Country:US
Practice Address - Phone:336-718-6770
Practice Address - Fax:336-277-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty