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131 Medical Park Rd Ste 308 Mooresville NC 28117-8525 | |
| (704) 660-2640 | |
| (704) 660-2646 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 131 Medical Park Rd Ste 308, Mooresville, North Carolina |
| Authorized Official Name and Position | Jennifer L Jackson (SR DIR PROV ENROLLMENT & ONBOARDING) |
| Authorized Official Contact | 6154657633 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4000 Meridian Blvd Franklin TN 37067-6325 Ph: (615) 465-7230 | 131 Medical Park Rd Ste 308 Mooresville NC 28117-8525 Ph: (704) 660-2640 |
| NPI Number | 1518361914 |
|---|---|
| Provider Enumeration Date | 10/14/2014 |
| Last Update Date | 01/14/2022 |
| Certification Date | 01/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518361914 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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