| Novant Health South Park Family Physicians | |
|
6324 Fairview Road Suite 201 Charlotte NC 28210-4278 | |
| (704) 384-0588 | |
| (704) 384-0580 |
| Full Name | Novant Health South Park Family Physicians |
|---|---|
| Speciality | Family Medicine |
| Location | 6324 Fairview Road, Charlotte, North Carolina |
| Authorized Official Name and Position | Leea Jeanine Walton (RCS MANAGER) |
| Authorized Official Contact | 7043166081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Novant Health South Park Family Physicians Po Box 60447 Charlotte NC 28260-0447 Ph: (704) 384-0588 | Novant Health South Park Family Physicians 6324 Fairview Road Suite 201 Charlotte NC 28210-4278 Ph: (704) 384-0588 |
| NPI Number | 1770511313 |
|---|---|
| Provider Enumeration Date | 06/30/2006 |
| Last Update Date | 07/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770511313 | NPI | - | NPPES |
| CC5118 | Other | NC | RAILROAD MEDICARE |
| 017X3 | Other | NC | BCBS NC |
| NPB165 | Medicaid | SC | |
| 5903451 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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