NPIMap

Organization Active NPI

Novant Health Medical Group NC Coastal Region Specialty, LLC

  • Surgery Physician
  • Supply, NC
National Provider Identifier
1295633535
Registry record updated Oct 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
NOVANT HEALTH MEDICAL GROUP NC COASTAL REGION SPECIALTY, LLC
Practice address
13 Medical Campus Dr NW Ste 102
Supply, NC 28462-4093
Phone
(910) 754-5988
Fax
(910) 754-5989
NPI assigned
Oct 27, 2026
Last updated
Oct 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 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
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

13 Medical Campus Dr NW Ste 102
Supply, NC 28462-4093

Mailing address

PO Box 604532
Charlotte, NC 28260-4532

National Provider Directory

National Provider Directory
Tax ID family
Novant Health Medical Group NC Coastal Region Specialty LLC44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1793059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1793145600000",
    "number": "1295633535",
    "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": "13 MEDICAL CAMPUS DR NW STE 102",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284624093",
            "telephone_number": "910-754-5988",
            "fax_number": "910-754-5989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP NC COASTAL REGION SPECIALTY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-27",
        "last_updated": "2026-10-28",
        "certification_date": "2026-10-28",
        "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": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Supply, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.