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Organization
SOUTHERN FAMILY MEDICINE, INC.
Active
Organization
SOUTHERN FAMILY MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA JARVIS MICOLUCCI LCMHCS (CEO)
(704) 953-4890
Entity
Organization
Contact information
Practice address
400 E STATESVILLE AVE STE 200, MOORESVILLE, NC 28115-2588
(704) 360-8486
(704) 230-4674
Mailing address
400 E STATESVILLE AVE STE 200, MOORESVILLE, NC 28115-2588
(704) 360-8486
(704) 230-4674
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/05/2016
Last updated
01/14/2026
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