Statesville Hma Medical Group, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

STATESVILLE HMA MEDICAL GROUP, LLC

Practice address

1412 Fern Creek Dr
Statesville, NC 28625-9376

Phone

(704) 660-4145

NPI assigned

Dec 1, 2009

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

Part of

Statesville Hma Medical Gro

Locations

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

{
    "created_epoch": "1259625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1639407737",
    "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": "615-465-7000",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 FERN CREEK DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286259376",
            "telephone_number": "704-660-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATESVILLE HMA MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATESVILLE HMA MEDICAL GROUP LLC",
        "enumeration_date": "2009-12-01",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Statesville Hma Medical Group, LLC
• Statesville Hma Medical Group, LLC
• Statesville Hma Medical Group, LLC
• Statesville Hma Medical Group, LLC
• Statesville Hma Medical Group, LLC
• Statesville Hma Medical Group, LLC
• Statesville Hma Medical Group, LLC
• Statesville Hma Medical Group, LLC
• Statesville Hma Medical Group, LLC
• Statesville Hma Physician Management Inc

• Family Medicine Physician in Statesville, NC
• Providers in Statesville, 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.