Statesville Hma Medical Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

STATESVILLE HMA MEDICAL GROUP, LLC

Doing business as

Davis Internal Medicine

Practice address

1424 Fern Creek Dr Ste D
Statesville, NC 28625-9376

Phone

(704) 838-7080

Fax

(704) 978-2478

NPI assigned

Feb 2, 2011

Organization subpart

Yes

Parent organization

STATESVILLE HMA MEDICAL GROUP LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Jennifer L Jackson

Title

Sr Dir Prov Enrollment & Onboarding

Phone

(615) 465-3334

Specialties & licenses 1

Addresses

Other names 1

• Davis Internal Medicine Doing business as

Part of

Statesville Hma Medical Group LLC

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

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1457657868",
    "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": "1424 FERN CREEK DR STE D",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286259376",
            "telephone_number": "704-838-7080",
            "fax_number": "704-978-2478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATESVILLE HMA MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATESVILLE HMA MEDICAL GROUP LLC",
        "enumeration_date": "2011-02-02",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "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": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Davis Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Statesville Hma Medical Group, LLC

• Internal Medicine Physician in Statesville, NC
• Providers in Statesville, NC by specialty
• Internal 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.