Southpark Pediatrics, P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

9501464 Issued in NC

Legal business name

SOUTHPARK PEDIATRICS, P.A.

Practice address

4601 Park Rd
Suite 100
Charlotte, NC 28209-3239

Phone

(704) 522-6656

Fax

(704) 522-6665

NPI assigned

Nov 20, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Leslie C Brown

Title

Practice Administrator

Phone

(704) 896-9830

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1258675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258675200000",
    "number": "1710215256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 PARK RD",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093239",
            "telephone_number": "704-522-6656",
            "fax_number": "704-522-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 PARK RD",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093239",
            "telephone_number": "704-522-6656",
            "fax_number": "704-522-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPARK PEDIATRICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-20",
        "last_updated": "2009-11-20",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "704-896-9830",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "9501464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89013J5",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southminster Inc
• Southpark Behavioral Medicine Specialists, P.a.
• Southpark Chiropractic Center Inc
• Southpark Counseling PLLC
• Southpark Functional Medicine PLLC
• Southpark Psychotherapy PLLC (SouthPark Psychotherapy)
• Southpark Senior Living LLC (Place at Southpark Assisted Living and Memory Care)
• Southpark Surgery Center LLC (SouthPark Surgery Center)
• Southside Counseling Center, LLC
• Southview Dentistry

• Specialist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2009; 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.