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Contact Information

NOVANT HEALTH MEDICAL GROUP, LLC
1918 RANDOLPH RD STE 210
CHARLOTTE, NC28207-1109
 Phone: 704-316-5060
 Fax: 704-316-5069
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatric Gastroenterology

2080P0206X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for NOVANT HEALTH MEDICAL GROUP, LLC

NPI # 1003966185
LBN Legal business name NOVANT HEALTH MEDICAL GROUP, LLC
Authorized official LEEA WALTON - (EDI MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/11/2007
Last updated 07/31/2025 - About 10 months ago
Identifiers
NC Medicaid 5905866
SC Medicaid NPB219
NC Other 018WH BCBS NC
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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