Novant Medical Group Inc

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

NOVANT MEDICAL GROUP INC

Practice address

1710 Kernersville Medical Pkwy
Ste 220
Kernersville, NC 27284-7156

Phone

(336) 992-2140

Fax

(336) 992-2159

NPI assigned

May 31, 2012

Organization subpart

No

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

Authorized official

Name

Geoffrey K. Gardner

Title

VP of Finance

Phone

(704) 384-7283

Specialties & licenses 1

Addresses

Other names 1

• Novant Health Triad Plastic Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376524800000",
    "number": "1669733234",
    "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",
            "telephone_number": "336-992-2140",
            "fax_number": "336-992-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 KERNERSVILLE MEDICAL PKWY",
            "address_2": "STE 220",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847156",
            "telephone_number": "336-992-2140",
            "fax_number": "336-992-2159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-31",
        "last_updated": "2013-08-15",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "704-384-7283"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Triad Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Health Thomasville Medical Center, LLC
• Novant Medical Group
• Novant Medical Group Inc
• Novant Medical Group Inc
• Novant Medical Group Inc
• Novant Medical Group Inc.
• Novant Medical Group, Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc

• Plastic and Reconstructive Surgery Physician in Kernersville, NC
• Providers in Kernersville, NC by specialty
• Plastic and Reconstructive Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2013; 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.