Mooresville Ppm, LLC

NPI #1497031322 in Mooresville, North Carolina

Provider Information

NPI Number: 1497031322
Entity Type: Organization
Organization Name: Mooresville Ppm, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: MOORESVILLE PPM, LLC
Primary Specialty: Internal Medicine
Enumeration Date: Oct 24, 2011
Last Updated: Jan 14, 2022

Practice Location

Address: 478 WILLIAMSON RD
Address 2: SUITE B
City: Mooresville
State: North Carolina
ZIP Code: 28117-8192
Phone: (704) 660-0321

Authorized Official

Name: MRS. JENNY L JACKSON
Title: SR DIR PROV ENROLLMMENT & ONBOARDIN
Phone: (615) 465-3334

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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