Organization
SOUTH LAKE PEDIATRICS
Active
Parent organization
SOUTH LAKE PEDIATRICS
Other names
South Lake Pediatrics, Atrium Health Levine Children's South Lake Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTH LAKE PEDIATRICS
Authorized official
SCOTT RISSMILLER (ENTERPRISE EVP)
(704) 355-8675
Entity
Organization
Contact information
Practice address
9625 NORTHCROSS CENTER CT, STE 201, HUNTERSVILLE, NC 28078-7348
(704) 801-3097
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
(704) 631-0002
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
07/06/2006
Last updated
03/09/2023
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