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Organization

STATESVILLE HMA MEDICAL GROUP, LLC

Active
Parent organization
STATESVILLE HMA MEDICAL GROUP LLC
Other names
Carolina Urology Care
Organization subpart
Yes

Provider details

NPI number
Legal business name
STATESVILLE HMA MEDICAL GROUP LLC
Authorized official
MRS. JENNIFER L JACKSON (SIR DIR PROV ENROLLMENT & ONBOARDIN)
(615) 465-3334
Entity
Organization

Contact information

Practice address
1424 FERN CREEK DR, SUITE B, STATESVILLE, NC 28625-9376
(704) 662-9870
(704) 662-9788
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7230

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary

Other

Enumeration date
10/04/2011
Last updated
01/14/2022
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