NPIMap

Organization Active NPI

Novant Health Medical Group Coastal Region, LLC

Doing business as Novant Health Cancer Institute

  • Hematology & Oncology Physician
  • Carolina Shores, NC
National Provider Identifier
1801565684
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Doing business as
Novant Health Cancer Institute
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
Last updated
Sep 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Authorized official

Name
Shala Davis
Title
Enrollment Manager
Phone
(704) 303-7517

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X Primary
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 1

  • Novant Health Cancer Institute 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 LLC60 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

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

View all 23

Locations

125 Queens Rd
Ste 150
Charlotte, NC 28204
Phone (980) 302-6144

125 Queens Rd
Ste 400
Charlotte, NC 28204
Phone (980) 302-6400

125 Queens Rd
Ste 660
Charlotte, NC 28204
Phone (980) 302-6760

3515 W Market St
Ste 300
Greensboro, NC 27403
Phone (336) 660-5540

500 Pineview Dr
Ste 101
Kernersville, NC 27284
Phone (336) 992-1351

1450 Matthews Township Pkwy
#335
Matthews, NC 28105

1450 Matthews Township Pkwy
Ste 320
Matthews, NC 28105
Phone (704) 377-3900

170 Medical Park Rd
Ste 101
Mooresville, NC 28117
Phone (704) 799-3946

109 Scotts Hill Medical Dr
Ste 102
Wilmington, NC 28411
Phone (910) 662-1730

5505 Currituck Dr
#100
Wilmington, NC 28403
Phone (910) 662-6000

4622 Country Club Rd
Ste 180
Winston Salem, NC 27104
Phone (336) 768-9535

Practitioners & affiliated clinicians

Practitioners 83

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.

View all 83

NPI Registry JSON

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

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1801565684",
    "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",
            "telephone_number": "910-667-4283",
            "fax_number": "910-338-0965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 EMERSON BAY RD STE 104",
            "city": "CAROLINA SHORES",
            "state": "NC",
            "postal_code": "284672498",
            "telephone_number": "910-667-4283",
            "fax_number": "910-338-0965"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2131 S 17th St",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284017407",
            "country_code": "US",
            "telephone_number": "910-667-3000",
            "fax_number": "910-815-5464",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Brabham Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285460201",
            "country_code": "US",
            "telephone_number": "910-667-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-07",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHALA",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "704-303-7517"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Cancer Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Cancer Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carolina Shores, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.