NOVANT MEDICAL GROUP INC (NPI# 1386019891) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386019891 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP INC |
| Other Organization Name | NOVANT HEALTH CHILD AND ADOLESCENT MEDICAL GROUP |
| Practice Address |
3614 Providence Rd S Suite 101 Waxhaw NC 28173-6309 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043848460 |
| Practice Fax Number | 7043848465 |
| Mailing Telephone | 7043847840 |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2015-12-15 |
| Authorized Official Name | GEOFFREY K GARDNER (VP OF FINANCE) |
| Authorized Official Telephone | 7043848460 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Child and Adolescent Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700433711 | Novant Medical Group Inc | Psychiatry & Neurology | 933 Rockford St Ste 2, Mount Airy, NC 27030-5323 | 2019-08-23 |
| 1205481009 | Novant Medical Group Inc | Dermatology | 6324 Fairview Rd # 200, Charlotte, NC 28210-3271 | 2019-08-08 |
| 1033675079 | Novant Medical Group Inc | Psychiatry & Neurology | 1918 Randolph Rd Ste 320, Charlotte, NC 28207-1109 | 2019-02-14 |
| 1205355799 | Novant Medical Group Inc | Family Medicine | 16525 Holly Crest Ln Ste 250, Huntersville, NC 28078-4912 | 2017-09-15 |
| 1679090468 | Novant Medical Group Inc | Internal Medicine | 12311 Copper Way Ste 100, Charlotte, NC 28277-3643 | 2017-08-23 |
| 1003332016 | Novant Medical Group Inc | Internal Medicine | 10030 Gilead Rd Ste 344, Huntersville, NC 28078-7545 | 2017-08-22 |
| 1255709432 | Novant Medical Group Inc | Family Medicine | 19485 Old Jetton Road, Suite 100, Cornelius, NC 28031-6583 | 2015-09-04 |
| 1215326665 | Novant Medical Group Inc | Surgery | 819 N Atlantic Ave, Southport, NC 28461-3531 | 2015-01-22 |
| 1194113662 | Novant Medical Group Inc | Obstetrics & Gynecology | 1730 Kernersville Medical Parkway, Suite 104, Kernersville, NC 27284-7198 | 2015-01-06 |
| 1437556594 | Novant Medical Group Inc | Internal Medicine | 13 Medical Campus, Suite 102, Supply, NC 28462-4093 | 2014-12-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Novant Medical Group Inc. | 2626 Glenwood Ave Ste 550, Raleigh, NC 27608 |
| Virginia Business Entities | Novant Medical Group Inc. | 2085 Frontis Plaza Blvd, Winston Salem, North Carolina 27103 |
| Street Address |
3614 PROVIDENCE RD S SUITE 101 |
| City | WAXHAW |
| State | NC |
| Zip Code | 28173-6309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679535652 | Sherry Demaison | Nurse Practitioner | 3614 Providence Rd S, Suite 200, Waxhaw, NC 28173-6309 | 2006-04-05 |
| 1902232143 | Cassie Lynnae Linker Boland | Pharmacist | 3614 Providence Rd S, Ste 200, Waxhaw, NC 28173-6309 | 2013-09-19 |
| 1275837411 | Novant Medical Group, Inc | Orthopaedic Surgery | 3614 Providence Rd S, Suite 200, Waxhaw, NC 28173-6310 | 2011-01-03 |
| 1215146535 | Anthony Q. Walker | Specialist | 3614 Providence Rd S, Suite 200, Waxhaw, NC 28173-6309 | 2007-05-22 |
| 1134348485 | Derrick Lewis Blackwell | Family Medicine | 3614 Providence Rd S, Ste 200, Waxhaw, NC 28173-6310 | 2007-04-25 |
| 1497979611 | Robert Malecki | Family Medicine | 3614 Providence Rd S, Suite 200, Waxhaw, NC 28173-6309 | 2007-04-11 |
| 1568400729 | Novant Medical Group, Inc. | Family Medicine | 3614 Providence Rd S, Suite 100, Waxhaw, NC 28173-6309 | 2006-06-02 |
| 1861455479 | William Martin | Family Medicine | 3614 Providence Rd S, Suite 200, Waxhaw, NC 28173-7394 | 2006-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033733175 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 1615 Providence Road South, Marvin, NC 28173 | 2020-06-04 |
| 1225507320 | Shane Markey Dds Ms Pllc | Dentist | 8412 New Town Rd Ste A, Waxhaw, NC 28173 | 2018-11-19 |
| 1336631514 | Suganya Nelatoor,d.d.s.,p.l.l.c. | Clinic/Center | 102 E Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2018-06-04 |
| 1184120750 | Restore Healthcare Medical Group | Counselor | 500 Waxhaw Professional Park Drive, Ste 105 F, Waxhaw, NC 28173 | 2018-04-03 |
| 1730690827 | Concrete Roses Consulting | Community/Behavioral Health | 5960 Fairview Road, 323, Charlotte, NC 28173 | 2017-10-17 |
| 1861849523 | Kayla Selena Caldwell | Social Worker | 3908 Rev. H. Morrison Rd., Waxhaw, NC 28173 | 2016-05-23 |
| 1588023782 | Teri Hipp | Counselor | 101-e Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2016-02-16 |
| 1710355508 | Caresmatic Phase 1,inc. | Assisted Living Facility | 520 Pembroke Ln., Waxhaw, NC 28173 | 2015-09-10 |
| 1437564838 | Anna Waddell Schneiderman | Counselor | 104 Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2014-06-24 |
| 1467892109 | Samantha Weidele Waldman | Counselor | 9929 Rea Rd Ste 201, Waxhaw, NC 28173 | 2013-06-26 |
| Find all providers in zip 28173 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699023648 | Carolinas Physicians Network Inc | Pediatrics | 2700 Providence Rd S, Ste 350, Waxhaw, NC 28173-6313 | 2012-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306268594 | Sollus Health, Pllc | Pediatrics | 547 Keisler Dr Ste 103, Cary, NC 27518-9309 | 2014-01-08 |
| 1740622166 | Sunshine Pediatric and Adolescent Care | Pediatrics | 1631 Midtown Pl Ste 107, Raleigh, NC 27609-1300 | 2013-07-26 |
| 1134265721 | Daniel Elmer Brown | Pediatrics | 2412 Ridge Rd, Raleigh, NC 27612-4759 | 2007-01-30 |
| 1417003385 | Renuka Shiv Harsh | Pediatrics | 218 Foust St Ste B, Asheboro, NC 27203-5476 | 2007-01-25 |
| 1932254687 | Rollyn Michelle Ornstein | Pediatrics | 4024 Stirrup Creek Drive, Durham, NC 27703 | 2007-01-24 |
| 1881743763 | Masoud Ahdieh | Pediatrics | 711 S Long Dr, Rockingham, NC 28379-4315 | 2007-01-09 |
| 1609966647 | Robert W Little | Pediatrics | 2505 S Mebane St, Suite A, Burlington, NC 27215-6385 | 2006-10-13 |
| 1487755567 | Charles Richardson Martin | Pediatrics | 2 Dewitt St, Jacksonville, NC 28540-5649 | 2006-09-25 |
| 1710094487 | William Clayton Hayes Jr. | Pediatrics | 825 Majestic Ct Ste B, Gastonia, NC 28054-5186 | 2006-08-25 |
| 1285650945 | Andrew Kenneth Kiluk | Pediatrics | 3701 John Platt Drive, Morehead City, NC 28557-3280 | 2006-07-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.