Organization
SOUTH LAKE PEDIATRICS
Active
Parent organization
SOUTH LAKE PEDIATRICS
Other names
South Lake Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTH LAKE PEDIATRICS
Authorized official
THOMAS LAYMON (SENIOR VICE PRESIDENT)
(704) 446-8250
Entity
Organization
Contact information
Practice address
9908 COULOAK DR, STE 103, CHARLOTTE, NC 28216-8678
(704) 801-2025
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
10/26/2009
Last updated
07/16/2020
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