MEDICARE: FORSYTH MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080B0002X	Pediatric Obesity Medicine Physician
2	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1154271740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORSYTH MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	2085 FRONTIS PLAZA BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5614
Country	:	US
Telephone Number	:	336-277-1611
Fax Number	:	336-277-9606

Provider Business Practice Location Address
First Line	:	307 N THIRD ST
Second Line	:
City	:	MEBANE
State	:	NC
Zip	:	27302-2405
Country	:	US
Telephone Number	:	336-962-5308
Fax Number	:	336-900-1328

Authorized Official
Title or Position	:	VP OPS & NEW DEVELOPMENT
Name	:	JODY GLENN MORRIS
Credential	:
Telephone Number	:	919-497-8401

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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