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Organization
STATESVILLE HMA MEDICAL GROUP LLC
Active
Organization
STATESVILLE HMA MEDICAL GROUP LLC
Active
Parent organization
STATESVILLE HMA MEDICAL GROUP LLC
Other names
CAROLINA PEDIATRIC AND ADOLESCENT MEDICINE
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATESVILLE HMA MEDICAL GROUP LLC
Authorized official
JENNIFER JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
1410 FERN CREEK DR, STATESVILLE, NC 28625-9376
(704) 978-2379
(704) 978-2380
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7230
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
10/29/2015
Last updated
01/14/2022
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