NPIMap

Organization Active NPI

Southlake Psychiatry PC

  • Psychiatry Physician
  • Davidson, NC
National Provider Identifier
1295921724
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
9300112 Issued in NC
Legal business name
SOUTHLAKE PSYCHIATRY PC
Practice address
903 Northeast Dr
Suite 301
Davidson, NC 28036
Phone
(704) 894-9309
Fax
(704) 894-9304
NPI assigned
Sep 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Authorized official

Name
Dr. Thomas Michael Fitzgerald, MD
Title
President
Phone
(704) 894-9309

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 9300112 NC Primary

Addresses

Primary practice location

903 Northeast Dr
Suite 301
Davidson, NC 28036

Mailing address

903 Northeast Dr
Suite 301
Davidson, NC 28036-7416
Phone (704) 894-9309

Other identifiers 2

IdentifierTypeStateIssuer
B3348OtherNCBCBS
8932269MedicaidNC

National Provider Directory

National Provider Directory

Locations

18047 W Catawba Ave
Ste 200
Cornelius, NC 28031
Phone (704) 894-9309

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754006400000",
    "number": "1295921724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 NORTHEAST DR",
            "address_2": "SUITE 301",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280367416",
            "telephone_number": "704-894-9309",
            "fax_number": "704-894-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 NORTHEAST DR",
            "address_2": "SUITE 301",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "28036",
            "telephone_number": "704-894-9309",
            "fax_number": "704-894-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE PSYCHIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A",
        "authorized_official_last_name": "FITZGERALD",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-894-9309",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "9300112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "B3348",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8932269",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davidson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; 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.