Novant Health Medical Group, LLC
Organization Active NPI Pediatrics Physician · Charlotte, NC
NPI 1205320306 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1205320306
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- NOVANT HEALTH MEDICAL GROUP, LLC
- Practice address
- 201 Queens Rd
Charlotte, NC 28204 - Phone
- (704) 316-3022
- NPI assigned
- Jun 21, 2018
- Organization subpart
- No
Authorized official
- Name
- Leea Jeanine Walton
- Title
- RCS Manager
- Phone
- (704) 316-6081
Corporate family (same tax ID) 24
Practitioners 3
-
Poornima Baddi, MD
-
Katy Flinn Johnson, PA-C
-
Juliana Atei Ofori-Mante, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031121000692 | NC | Part B Supplier - Clinic/Group Practice | 1153234893 |
Receives reassigned benefits from 3,607 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Presbyterian Inpt Care
Locations
1900 Randolph Rd
Ste 216
Charlotte, NC 28207
Phone (704) 316-5330
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
201 Queens Rd
Charlotte, NC 28204
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (844) 266-8268
Other names
- Novant Health Pediatric Infectious Disease
Other providers in Charlotte, NC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
All providers in Charlotte, NC · Pediatrics Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.