SOUTH LAKE PEDIATRICS
NPI 1619203791
Pediatrics in Charlotte, NC

Q: What is South Lake Pediatrics's NPI number?

The NPI number for South Lake Pediatrics is 1619203791. It was assigned to this organization in the NPPES registry on October 26, 2009.

Q: What is South Lake Pediatrics's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Active since October 26, 2009

9908 COULOAK DR, STE 103, CHARLOTTE, NC 28216(704) 801-2025 Get Directions Write a Review

NPPES record last updated: July 16, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 16, 2020, Jun 12, 2020, May 12, 2020 and 20 more (23 updates tracked since 2019).

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About South Lake Pediatrics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH LAKE PEDIATRICS (NPI 1619203791) is a healthcare organization registered as a pediatrics in Charlotte, North Carolina and active in the NPI registry since October 2009. The organization lists Thomas Laymon, Senior Vice President, as its authorized official.

NPPES Registry Identity

NPI1619203791

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameSOUTH LAKE PEDIATRICS

Location Address9908 COULOAK DR, STE 103Charlotte, NC 28216-8678

Mailing AddressPo Box 19305Charlotte, NC 28219-9305 · (704) 631-0002

Phone(704) 801-2025

Organization SubpartYes

Authorized OfficialThomas LaymonSenior Vice President · (704) 446-8250

Enumeration DateOctober 26, 2009

Last NPPES UpdateJuly 16, 202023 updates tracked since enumeration

✔ NPI 1619203791 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

9908 COULOAK DR, Charlotte, NC 28216

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Other Names 1

Other NameSouth Lake Pediatrics

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NICOLE LUDMIL IVANOV MD

Pediatrics

9908 COULOAK DR, STE 103
CHARLOTTE, NC 28216

Mecklenburg County (704) 801-2025

JOSEPH PINCKNEY JR. MD

Family Medicine

9908 COULOAK DR, STE 202
CHARLOTTE, NC 28216

Mecklenburg County (704) 801-3050

ROXANNE DENISE SEMPLE MD

Pediatrics

9908 COULOAK DR, STE 103
CHARLOTTE, NC 28216

Mecklenburg County (704) 801-2025

MARLAR ANNE VOLLBRECHT FNP

Nurse Practitioner (Family)

9908 COULOAK DR, STE 202
CHARLOTTE, NC 28216

Mecklenburg County (704) 801-3050

MOLLI RENE DUTT LOISELLE OT

Occupational Therapist

9908 COULOAK DR, STE 100
CHARLOTTE, NC 28216

Mecklenburg County (704) 801-3065

KELLEY HOWARD ROUSE MD

Obstetrics & Gynecology

9908 COULOAK DR, STE 201
CHARLOTTE, NC 28216

Mecklenburg County (704) 801-2075

HOLLIE CHAMPION GOLDBERG

Physical Therapist

9908 COULOAK DR
CHARLOTTE, NC 28216

Mecklenburg County (704) 801-3065

LAURA TUMBLIN ELHAGE MD

Pediatrics

9908 COULOAK DR, STE 103
CHARLOTTE, NC 28216

Mecklenburg County (704) 801-2025

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is South Lake Pediatrics's NPI number?

The NPI number for South Lake Pediatrics is 1619203791. It was assigned to this organization in the NPPES registry on October 26, 2009.

Where is South Lake Pediatrics located?

South Lake Pediatrics is located at 9908 Couloak Dr Ste 103, Charlotte, NC 28216. The listed phone number is (704) 801-2025.

What is South Lake Pediatrics's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

When was this NPI record last updated?

The NPPES record for South Lake Pediatrics was last updated on July 16, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.