Organization
STATESVILLE HMA MEDICAL GROUP LLC
Active
Other names
DAVIS MEDICAL GROUP OBSTETRICS & GYNECOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
555 KITCHINGS DR, STATESVILLE, NC 28677-3576
(704) 872-7294
(704) 872-4078
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7230
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
28478
NC
Other
Enumeration date
05/03/2017
Last updated
01/14/2022
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