Organization
MOORESVILLE PPM LLC
Active
Parent organization
MOORESVILLE PPM LLC
Other names
Lake Norman Orthopedic Spine Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOORESVILLE PPM LLC
Authorized official
MRS. JENNIFER L JACKSON (SIR DIR PROV ENROLLMENT & ONBOARDIN)
(615) 465-3334
Entity
Organization
Contact information
Practice address
170 MEDICAL PARK RD, SUITE 102, MOORESVILLE, NC 28117-8540
(704) 660-4756
(704) 660-4751
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7230
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Enumeration date
11/05/2011
Last updated
01/14/2022
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