# MOORESVILLE PPM LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MOORESVILLE PPM LLC
- **Other names:** Mooresville Family Practice
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1215214127
- **Legal business name:** MOORESVILLE PPM LLC
- **Authorized official:** JENNIFER L JACKSON (SR DIR PROV ENROLL & ONBOARDING)
- **Authorized official phone:** (615) 465-3334

## Contact information

- **Practice address:** 417 E STATESVILLE AVE, MOORESVILLE, NC 28115-2590
- **Practice address phone:** (704) 663-2389
- **Practice address fax:** (704) 663-4873
- **Mailing address:** PO BOX 689022, FRANKLIN, TN 37068-9022
- **Mailing address phone:** (615) 465-7230
- **Mailing address fax:** (615) 628-6677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/05/2011
- **Last updated:** 01/14/2022