SOUTHLAKE PSYCHIATRY PC – NPI #1295921724
Psychiatry & Neurology

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

SOUTHLAKE PSYCHIATRY PC is a psychiatry & neurologist located in DAVIDSON, NC. NPPES has assigned the NPI number 1295921724 to SOUTHLAKE PSYCHIATRY PC on September 18, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 2084P0800X from the Health Care Provider Taxonomy code set, which is classified as Psychiatry & Neurology, specializing in Psychiatry

The NPI profile was last updated on Aug 01, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SOUTHLAKE PSYCHIATRY PC below.

NPI Profile for
SOUTHLAKE PSYCHIATRY PC

NPI Number
1295921724
Enumeration Date

(more than 18 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SOUTHLAKE PSYCHIATRY PC
Primary location
903 NORTHEAST DR
SUITE 301
DAVIDSON, NC 28036
Phone: (704) 894-9309 Fax: (704) 894-9304
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
THOMAS FITZGERALD
PRESIDENT
Phone: (704) 894-9309
Updated
Certification Date
Aug 01, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for SOUTHLAKE PSYCHIATRY PC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
otherBCBSNCB3348
medicaidNC8932269
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2084P0800X
- Psychiatry & Neurology / Psychiatry (Primary)
NC 9300112

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.