# MOORESVILLE PPM LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MOORESVILLE PPM LLC
- **Other names:** Lakeshore Endocrinology
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1710384466
- **Legal business name:** MOORESVILLE PPM LLC
- **Authorized official:** JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
- **Authorized official phone:** (615) 465-3334

## Contact information

- **Practice address:** 134 MEDICAL PARK RD, SUITE 108, MOORESVILLE, NC 28117-8526
- **Practice address phone:** (704) 660-4669
- **Practice address fax:** (704) 660-4295
- **Mailing address:** 4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
- **Mailing address phone:** (615) 465-7230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/24/2014
- **Last updated:** 01/14/2022