Provider Demographics
NPI:1417404401
Name:SOUTH LAKE WOMEN'S HEALTHCARE PLLC
Entity Type:Organization
Organization Name:SOUTH LAKE WOMEN'S HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-896-9912
Mailing Address - Street 1:19453 W CATAWBA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4021
Mailing Address - Country:US
Mailing Address - Phone:704-896-9912
Mailing Address - Fax:704-896-9913
Practice Address - Street 1:19453 W CATAWBA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4021
Practice Address - Country:US
Practice Address - Phone:704-896-9912
Practice Address - Fax:704-896-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty