Organization
SOUTH LAKE EARS NOSE & THROAT PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STAN D PHILLIPS MD (OWNER)
(704) 896-1909
Entity
Organization
Contact information
Practice address
9710 SAM FURR RD UNIT D, HUNTERSVILLE, NC 28078-4928
(704) 896-1909
(704) 896-1926
Mailing address
9710 SAM FURR RD UNIT D, HUNTERSVILLE, NC 28078-4928
(704) 896-1909
(704) 896-1926
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
9701107
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891108A
—
NC
Enumeration date
02/27/2012
Last updated
02/27/2012
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