| Southlake Psychiatry Pc | |
|
903 Northeast Dr Suite 301 Davidson NC 28036 | |
| (704) 894-9309 | |
| (704) 894-9304 |
| Full Name | Southlake Psychiatry Pc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 903 Northeast Dr, Davidson, North Carolina |
| Authorized Official Name and Position | Thomas Michael Fitzgerald (PRESIDENT) |
| Authorized Official Contact | 7048949309 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southlake Psychiatry Pc 903 Northeast Dr Suite 301 Davidson NC 28036-7416 Ph: (704) 894-9309 | Southlake Psychiatry Pc 903 Northeast Dr Suite 301 Davidson NC 28036 Ph: (704) 894-9309 |
| NPI Number | 1295921724 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 06/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295921724 | NPI | - | NPPES |
| B3348 | Other | NC | BCBS |
| 8932269 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 9300112 (North Carolina) | Primary |
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Alloway Consulting, P.l.l.c. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 903 Northeast Drive, Suite 101, Davidson, NC 28036 Phone: 704-655-2828 Fax: 704-655-2830 | |
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Triple Play Farm, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 19516 Kistler Farm Rd, Davidson, NC 28036 Phone: 704-608-8441 | |
Southlake Counseling & Consulting Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 903 Northeast Dr Ste 201, Davidson, NC 28036 Phone: 704-896-7776 Fax: 704-896-0992 | |
Davidson Clergy Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 455 S Main St, Suite 200, Davidson, NC 28036 Phone: 704-895-6487 Fax: 704-655-1481 | |
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