# STATESVILLE HMA MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** STATESVILLE HMA MEDICAL GROUP LLC
- **Other names:** CAROLINA PEDIATRIC AND ADOLESCENT MEDICINE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1730551714
- **Legal business name:** STATESVILLE HMA MEDICAL GROUP LLC
- **Authorized official:** JENNIFER JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
- **Authorized official phone:** (615) 465-3334

## Contact information

- **Practice address:** 1410 FERN CREEK DR, STATESVILLE, NC 28625-9376
- **Practice address phone:** (704) 978-2379
- **Practice address fax:** (704) 978-2380
- **Mailing address:** 4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
- **Mailing address phone:** (615) 465-7230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/29/2015
- **Last updated:** 01/14/2022