Organization
MOORESVILLE PPM LLC
Active
Parent organization
MOORESVILLE PPM LLC
Other names
Lake Norman Orthopedic & Sports Medicine
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
202 WILLIAMSON RD, SUITE 100, MOORESVILLE, NC 28117-7610
(704) 799-7811
(704) 799-7812
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7230
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
Other
Enumeration date
11/05/2011
Last updated
01/14/2022
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