MEDICARE: FORSYTH MEMORIAL HOSPITAL, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	363A00000X	Physician Assistant
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1891828562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORSYTH MEMORIAL HOSPITAL, INC

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:	336-718-4820
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 STADIUM OAKS DR
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8962
Country	:	US
Telephone Number	:	336-766-0547
Fax Number	:

Authorized Official
Title or Position	:	RCS MANAGER
Name	:	SHALA DAVIS
Credential	:
Telephone Number	:	704-303-7517

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/12/2023

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