Organization
MOORESVILLE PPM, LLC
Active
Parent organization
MOORESVILLE PPM, LLC
Other names
Lake Norman Medical Group Heart & Vascular Statesville
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOORESVILLE PPM, LLC
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLL & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
1424 FERN CREEK DR STE D, STATESVILLE, NC 28625-9376
(704) 878-2058
(704) 872-6576
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7230
(615) 628-6677
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
—
—
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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