NPIMap

Organization Active NPI

Novant Health Medical Group Coastal Region, LLC

Doing business as Novant Health Psychiatry Residency Clinic

  • Psychiatry Physician
  • Wilmington, NC
National Provider Identifier
1063203941
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Doing business as
Novant Health Psychiatry Residency Clinic
Practice address
416 N 30TH St
Wilmington, NC 28405-3158
Phone
(910) 667-7000
Fax
(910) 815-5850
NPI assigned
May 13, 2025
Last updated
May 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Authorized official

Name
Leea Jeanine Walton
Title
Enrollment Manager
Phone
(336) 515-7085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

416 N 30TH St
Wilmington, NC 28405-3158

Mailing address

PO Box 936857
Atlanta, GA 31193-6857

Other names 1

  • Novant Health Psychiatry Residency Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210408000285 NC Part B Supplier - Clinic/Group Practice 2860809936 Receives reassigned benefits from 798 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Wilmington, NC; Wilmington, NE; Boivia, NC; Bolivia, NC; Burgaw, NC; Carolina Shores, NC; Jacksonville, NC; Leland, NC…

National Provider Directory

National Provider Directory
Tax ID family
Novant Health Medical Group Coastal Region LLC56 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1747094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1063203941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 N 30TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284053158",
            "telephone_number": "910-667-7000",
            "fax_number": "910-815-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-13",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "336-515-7085"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Psychiatry Residency Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; 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.