Organization
MOORESVILLE PPM LLC
Active
Parent organization
MOORESVILLE PPM LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOORESVILLE PPM LLC
Authorized official
MRS. JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
131 MEDICAL PARK RD, SUITE 302, MOORESVILLE, NC 28117-8522
(704) 660-4750
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7000
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207X00000X
Orthopaedic Surgery Physician
22538
NC
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
208000000X
Pediatrics Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208600000X
Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/02/2009
Last updated
01/14/2022
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