Organization
STATESVILLE HMA MEDICAL GROUP LLC
Active
Parent organization
STATESVILLE HMA MEDICAL GROUP LLC
Other names
Statesville Vascular Institute
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATESVILLE HMA MEDICAL GROUP LLC
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
218 OLD MOCKSVILLE RD, STATESVILLE, NC 28625-1930
(704) 838-7165
(704) 878-2081
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7203
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Enumeration date
05/22/2013
Last updated
01/14/2022
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