Novant Medical Group, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

NOVANT MEDICAL GROUP, INC.

Doing business as

Novant Health Internal Medicine Providence

Practice address

7903 Providence Rd Ste 100
Charlotte, NC 28277-9763

Phone

(704) 384-7680

NPI assigned

Apr 12, 2018

Last updated

Aug 18, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shala Davis

Title

RCS MGR

Phone

(704) 303-7517

Specialties & licenses 1

Addresses

Other names 1

• Novant Health Internal Medicine Providence Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marianthe Manak Burns, MD

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1952353708
  NPD
• Zoe M Comer, NP

  • Nurse Practitioner
  • Winston Salem, NC
  • NPI 1871722538
  NPD
• Ashley Miller Perrott, MD

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1659408268
  NPD
• Stephanie Anne Thornton, NP-C

  • Nurse Practitioner
  • Winston Salem, NC
  • NPI 1770968273
  NPD

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

{
    "created_epoch": "1523491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1023515202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7903 PROVIDENCE RD STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282779763",
            "telephone_number": "704-384-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-12",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHALA",
        "authorized_official_title_or_position": "RCS MGR",
        "authorized_official_telephone_number": "704-303-7517"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Internal Medicine Providence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Medical Group, Inc (Novant Health Pediatric Arboretum)
• Novant Medical Group, Inc (Novant Health Neurology and Sleep)
• Novant Medical Group, Inc (Rankin Womens Center)
• Novant Medical Group, Inc. (South Park Pediatrics)
• Novant Medical Group, Inc. (Novant Health Pediatric Gastroenterology)
• Novant Medical Group, Inc. (Novant Health Hepatobillary & Pancreas)
• Novant Medical Group, Inc. (Mint Hill Family Practice)
• Novant Medical Group, Inc. (Novant Health NoDa OBGYN)
• Novant Medical Group, Inc. (Novant Health Brain and Spine Surgery)
• Novant Medical Group, Inc. (Novant Health Pediatrics Plaza Midwood)

• Internal Medicine Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.