Mooresville Ppm LLC

NPI #1912287467 in Mooresville, North Carolina

Provider Information

NPI Number: 1912287467
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: Aug 27, 2011
Last Updated: Jan 14, 2022

Practice Location

Address: 157 PROFESSIONAL PARK DR
Address 2: SUITE A
City: Mooresville
State: North Carolina
ZIP Code: 28117-5605
Phone: (704) 662-3967

Authorized Official

Name: MRS. JENNIFER L JACKSON
Title: SR DIR PROV ENROLLMENT & ONBOARDING
Phone: (615) 465-3334

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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