Novant Medical Group, INC.
Urology, Pediatric Urology in Matthews, NC. Organization (NPI-2).
NPI number1699095331
StatusActive
Last updated in NPPESJun 4, 2010
Details
- NPI
- 1699095331
- Entity type
- Organization (NPI-2)
- Legal business name
- Novant Medical Group, INC.
- Organization subpart
- No
- Enumeration date
- Jun 4, 2010
- Last updated
- Jun 4, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2088P0231X | Urology, Pediatric Urology | – | – | Yes |
| 208800000X | Urology | – | – |
Other names
- Southeast Children'S Urology (Doing Business As)
Practice location
1401 Matthews Township PkwySuite 312
Matthews, NC 28105-5402
Phone 704-384-9530 · Fax 704-384-9535
Mailing address
Po Box 60447Charlotte, NC 28260-0447
Phone 704-384-7840 · Fax 704-384-7830
Authorized official
Geoffrey Gardner
Vp Of Finance
7043849094
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