Organization
MOORESVILLE PPM LLC
Active
Parent organization
MOORESVILLE PPM LLC
Other names
Campbell Surgical
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
123 PROFESSIONAL PARK DR STE 101, MOORESVILLE, NC 28117-5516
(704) 663-7905
(704) 360-4954
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7230
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
09/04/2013
Last updated
01/14/2022
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