Organization
STATESVILLE HMA MEDICAL GROUP, LLC
Active
Parent organization
STATESVILLE HMA MEDICAL GROUP LLC
Other names
Carolina Urology Care-Statesville
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATESVILLE HMA MEDICAL GROUP LLC
Authorized official
MRS. JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
1410 FERN CREEK DR, STATESVILLE, NC 28625-9376
(704) 873-6863
(704) 873-6859
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7230
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
11/30/2011
Last updated
01/14/2022
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