Organization
SOUTHLAKE PSYCHIATRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS MICHAEL FITZGERALD MD (PRESIDENT)
(704) 894-9309
Entity
Organization
Contact information
Practice address
903 NORTHEAST DR, SUITE 301, DAVIDSON, NC 28036
(704) 894-9309
(704) 894-9304
Mailing address
903 NORTHEAST DR, SUITE 301, DAVIDSON, NC 28036-7416
(704) 894-9309
(704) 894-9304
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
9300112
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8932269
—
NC
01
—
B3348
BCBS
NC
Enumeration date
09/18/2007
Last updated
08/01/2025
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