Novant Health Medical Group Coastal Region, LLC
Organization Active NPI Hematology & Oncology Physician · Carolina Shores, NC
NPI 1801565684 · NPPES record last updated Sep 18, 2025
Key facts
- NPI
- 1801565684
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- Legal business name
- NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
- Practice address
- 75 Emerson Bay Rd Ste 104
Carolina Shores, NC 28467-2498 - Phone
- (910) 667-4283
- Fax
- (910) 338-0965
- NPI assigned
- Sep 7, 2021
- Organization subpart
- No
Authorized official
- Name
- Shala Davis
- Title
- Enrollment Manager
- Phone
- (704) 303-7517
Corporate family (same tax ID) 22
Practitioners 83
-
Yves Christian Verdieu, PA-C
-
Charles Kofi Agbemabiese, M.D.
-
Madan Raj Aryal, MD
-
Aakanksha Asija, MD
-
Hope Duet Beacham, ACNP
-
Tami Jo Bruggeman, MSN, APRN, FNP-BC
-
Nusrat Ahmad Chaudhary, M.D.
-
Franklin Liu Chen, M.D.
-
Andrew Shipe Dothard, M.D.
-
Stephanie Caudle Draker, NP-C
-
Madhu Kumar Emani, M.D.
-
Janelle Marie Fauci, M.D.
-
Anita Fei, MD
-
Julie Georgean Francisco, PA-C
-
Lilian M. Harris, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Novant Health Medical Group Coastal Region LLC
Locations
125 Queens Rd
Charlotte, NC 28204
Phone (980) 302-6380
301 Hawthorne Ln
Ste 100
Charlotte, NC 28204
Phone (704) 384-1900
125 Queens Rd
Ste 640
Charlotte, NC 28204
Phone (980) 302-6761
14135 Ballantyne Corporate Pl
Ste 200
Charlotte, NC 28277
Phone (704) 841-8151
330 Billingsley Rd
Ste 202
Charlotte, NC 28211
Phone (704) 316-2350
125 Queens Rd
Ste 430
Charlotte, NC 28204
Phone (980) 302-6300
8401 University Exec Park Dr
Ste 126
Charlotte, NC 28262
Phone (704) 549-3005
125 Queens Rd
Ste 520
Charlotte, NC 28204
Phone (980) 302-6500
125 Queens Rd
Ste 560
Charlotte, NC 28204
Phone (980) 302-6270
1450 Matthews Township Pkwy
Ste 380
Matthews, NC 28105
Phone (704) 264-3500
1450 Matthews Township Pkwy
#335
Matthews, NC 28105
631 Mocksville Ave
Ste 120
Salisbury, NC 28144
6488 Weddington Rd
Wesley Chapel, NC 28104
Phone (704) 316-5650
190 Kimel Park Dr
Ste 125
Winston Salem, NC 27103
Phone (336) 277-6009
4622 Country Club Rd
Ste 180
Winston Salem, NC 27104
Phone (336) 768-9535
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician |
207RH0003X | Yes | ||
| Gynecologic Oncology Physician |
207VX0201X |
Addresses
Primary practice location
75 Emerson Bay Rd Ste 104
Carolina Shores, NC 28467-2498
Mailing address
PO Box 936857
Atlanta, GA 31193-6857
Phone (910) 667-4283
Other practice location 1
2131 S 17th St
Wilmington, NC 28401-7407
Phone (910) 667-3000
Other practice location 2
2000 Brabham Ave
Jacksonville, NC 28546-0201
Phone (910) 667-3000
Other names
- Novant Health Cancer Institute
Other providers in Carolina Shores, NC
- Shawn Paul Johnson
- Stephen Bruce Jones
- Level Up Physical Therapy Inc
- Ross Alden Lippard
- Novant Health Medical Group Coastal Region, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Don J Olivero
- Ashlee Pinion-Raby
- Anne Marie Rakip
All providers in Carolina Shores, NC · Hematology & Oncology 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 Sep 18, 2025. 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.