NOVANT HEALTH MAXILLOFACIAL SURGERY
NPI 1902485600
Oral & Maxillofacial Surgery in Wilmington, NC

Q: What is Novant Health Medical Group Coastal Region, LLC's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Active since April 08, 2021CLIA 34D2302512 · Waiver

2131 S 17TH ST, WILMINGTON, NC 28401(910) 662-9300(910) 662-9301 Get Directions Write a Review

NPPES record last updated: March 28, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 28, 2023, Jul 19, 2021, May 24, 2021 and 2 more (5 updates tracked since 2021).

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About Novant Health Maxillofacial Surgery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NOVANT HEALTH MAXILLOFACIAL SURGERY (NPI 1902485600) is a healthcare organization registered as an oral & maxillofacial surgery in Wilmington, North Carolina and active in the NPI registry since April 2021. The organization holds a CLIA Waiver certificate valid through April 10, 2028, maintains 3 additional practice locations, and lists Shala Davis, Rcs Manager, as its authorized official.

NPPES Registry Identity

NPI1902485600

Entity TypeOrganization

Primary Taxonomy204E00000X

Legal Business NameNOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC

Location Address2131 S 17TH STWilmington, NC 28401-7407

Mailing AddressPo Box 936857Atlanta, GA 31193-6857 · (910) 667-7000 · Fax (910) 662-9301

Phone(910) 662-9300

Fax(910) 662-9301

Organization SubpartNo

Authorized OfficialShala DavisRcs Manager · (704) 303-7517

Enumeration DateApril 8, 2021

Last NPPES UpdateMarch 28, 20235 updates tracked since enumeration

NPPES CertifiedMarch 28, 2023

✔ NPI 1902485600 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOral & Maxillofacial SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code204E00000X

Definition

Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.

2131 S 17TH ST, Wilmington, NC 28401

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Other Names 2

Doing Business AsNovant Health Maxillofacial Surgery

Doing Business AsNhrmc Physician Specialists - Maxillofacial Surgery

Secondary Practice Locations 3

Location 11725 New Hanover Medical Park DrWilmington, NC 28403-5345 · Phone (910) 662-9300 · Fax (910) 662-9301

Location 22000 Brabham AveJacksonville, NC 28546-0201 · Phone (910) 667-7000 · Fax (910) 662-9301

Location 32259 S 17th StWilmington, NC 28401-7542 · Phone (910) 662-9300 · Fax (910) 662-9301

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2302512

Novant Health Maxillofacial Surgery - Autumn Hall · Wilmington, NC

Active · expires Apr 10, 2028

CLIA Number34D2302512

Laboratory TypePhysician Office

Certificate Effective DateApril 11, 2026

Certificate Expiration DateApril 10, 2028

Laboratory DirectorWanli Cheng

Laboratory Phone(910) 662-9300

Laboratory LocationNovant Health Maxillofacial Surgery - Autumn Hall5505 Currituck Drive Suite 200, Wilmington, NC 28403

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NEW HANOVER REGIONAL MEDICAL CENTER

Rehabilitation Hospital