Mooresville PPM LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MOORESVILLE PPM LLC

Doing business as

Primary Care Associates-Williamson

Practice address

396 Williamson Rd
Mooresville, NC 28117-5935

Phone

(704) 664-2216

Fax

(704) 664-6529

NPI assigned

Nov 30, 2011

Organization subpart

Yes

Parent organization

MOORESVILLE PPM LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jenny L Jackson

Title

Sr Dir Prov Enrollment & Onboarding

Phone

(615) 465-3334

Specialties & licenses 1

Addresses

Other names 1

• Primary Care Associates-Williamson Doing business as

Part of

Mooresville PPM LLC

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1225305576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MERIDIAN BLVD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370676325",
            "telephone_number": "615-465-7230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 WILLIAMSON RD",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175935",
            "telephone_number": "704-664-2216",
            "fax_number": "704-664-6529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORESVILLE PPM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOORESVILLE PPM LLC",
        "enumeration_date": "2011-11-30",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
        "authorized_official_telephone_number": "615-465-3334",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Care Associates-Williamson",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Primary Care Associates-Williamson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mooresville PPM LLC
• Mooresville PPM LLC
• Mooresville PPM LLC
• Mooresville PPM LLC
• Mooresville PPM LLC

• Family Medicine Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.