South Lake Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

SOUTH LAKE PEDIATRICS

Practice address

9908 Couloak Dr
Ste 103
Charlotte, NC 28216-8678

Phone

(704) 801-2025

NPI assigned

Oct 26, 2009

Organization subpart

Yes

Parent organization

SOUTH LAKE PEDIATRICSAs reported in NPPES

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

Authorized official

Name

Thomas Laymon

Title

Senior Vice President

Phone

(704) 446-8250

Specialties & licenses 1

Addresses

Other names 1

• South Lake Pediatrics Doing business as

Tax ID family

South Lake Pediatrics3 organizations share this tax ID, including this one

Part of

South Lake Pediatrics

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• South Lake Pediatrics

  • Pediatrics Physician
  • Huntersville, NC
  • NPI 1295766079
  NPD tax ID
• South Lake Pediatrics

  • Pediatrics Physician
  • Denver, NC
  • NPI 1740755610
  NPD tax ID

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

{
    "created_epoch": "1256515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594857600000",
    "number": "1619203791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9908 COULOAK DR",
            "address_2": "STE 103",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282168678",
            "telephone_number": "704-801-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE PEDIATRICS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH LAKE PEDIATRICS",
        "enumeration_date": "2009-10-26",
        "last_updated": "2020-07-16",
        "status": "A",
        "authorized_official_last_name": "LAYMON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "704-446-8250"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Lake Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Lake Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Charlotte Primary Care
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• South Charlotte Rheumatology, PLLC
• South East Mecklenburg County Health Department
• South Fork Optometric Associates, P.a.
• South Park Aesthetics
• South Park Behavioral
• South Park Oral Surgery
• Katherine Allison South
• Southcross Family Medicine PLLC

• Pediatrics Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; 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.