Organization
MOORESVILLE PPM LLC
Active
Parent organization
MOORESVILLE PPM LLC
Other names
Lakeshore Endocrinology
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOORESVILLE PPM LLC
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
134 MEDICAL PARK RD, SUITE 108, MOORESVILLE, NC 28117-8526
(704) 660-4669
(704) 660-4295
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7230
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Enumeration date
11/24/2014
Last updated
01/14/2022
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