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Organization Active NPI

Novant Health Medical Group NC Coastal Region Specialty, LLC

Doing business as Novant Health Psychiatric Medicine

  • Psychiatry Physician
  • Shallotte, NC
National Provider Identifier
1013821412
Registry record updated Oct 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
NOVANT HEALTH MEDICAL GROUP NC COASTAL REGION SPECIALTY, LLC
Doing business as
Novant Health Psychiatric Medicine
Practice address
512 Village Rd Ste 104
Shallotte, NC 28470-3409
Phone
(910) 721-4200
Fax
(910) 754-3811
NPI assigned
Oct 1, 2026
Last updated
Oct 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leea Jeanine Walton
Title
RCS Manager
Phone
(704) 316-6081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

512 Village Rd Ste 104
Shallotte, NC 28470-3409

Mailing address

PO Box 604532
Charlotte, NC 28260-4532

Other names 1

  • Novant Health Psychiatric Medicine Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1790812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790812800000",
    "number": "1013821412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604532",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282604532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 VILLAGE RD STE 104",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284703409",
            "telephone_number": "910-721-4200",
            "fax_number": "910-754-3811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP NC COASTAL REGION SPECIALTY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-01",
        "last_updated": "2026-10-01",
        "certification_date": "2026-10-01",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Psychiatric Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shallotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.