SOUTH LAKE PEDIATRICS NPI 1619203791

NPI Information

  • NPI: 1619203791
  • Provider Name: SOUTH LAKE PEDIATRICS
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • : SOUTH LAKE PEDIATRICS
  • Address: 9908 COULOAK DR
    STE 103
    CHARLOTTE, NC
    ZIP 28216
  • Phone: (704) 801-2025

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NPI Details

SOUTH LAKE PEDIATRICS is a pediatrics in Charlotte, NC. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. SOUTH LAKE PEDIATRICS NPI is 1619203791. The provider is registered as an organization entity type and is a single specialty group.
The provider South Lake Pediatrics.

The provider's business location address is:

9908 COULOAK DR
STE 103
CHARLOTTE, NC
ZIP 28216-678
Phone: (704) 801-2025

The provider's authorized official is Thomas Laymon .
The authorized official title is Senior Vice President and has the following contact phone number (704) 446-8250.

The enumeration date for this NPI number is 10/26/2009 and was last updated on 7/16/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsYes

What is NPI?

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This page was last updated on: 11/21/2025

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