Healthcare Provider Details

I. General information

NPI: 1588698559
Provider Name (Legal Business Name): SOUTHPARK BEHAVIORAL MEDICINE SPECIALISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 FAIRVIEW RD
CHARLOTTE NC
28210-3500
US

IV. Provider business mailing address

6845 FAIRVIEW RD
CHARLOTTE NC
28210-3500
US

V. Phone/Fax

Practice location:
  • Phone: 704-442-1655
  • Fax: 704-442-9360
Mailing address:
  • Phone: 704-442-1655
  • Fax: 704-442-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9300426
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number9300426
License Number StateNC

VIII. Authorized Official

Name: DR. PATRICIA K BOYER
Title or Position: OWNER
Credential: M.D.
Phone: 704-442-1655