# SOUTH LAKE EARS NOSE & THROAT PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154695872
- **Authorized official:** STAN D PHILLIPS MD (OWNER)
- **Authorized official phone:** (704) 896-1909

## Contact information

- **Practice address:** 9710 SAM FURR RD UNIT D, HUNTERSVILLE, NC 28078-4928
- **Practice address phone:** (704) 896-1909
- **Practice address fax:** (704) 896-1926
- **Mailing address:** 9710 SAM FURR RD UNIT D, HUNTERSVILLE, NC 28078-4928
- **Mailing address phone:** (704) 896-1909
- **Mailing address fax:** (704) 896-1926

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | 9701107 | NC | Yes |

## Other

- **Enumeration date:** 02/27/2012
- **Last updated:** 02/27/2012