Healthcare Provider Details

I. General information

NPI: 1407669997
Provider Name (Legal Business Name): FORSYTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7006 SHANNON WILLOW RD STE A
CHARLOTTE NC
28226-1318
US

IV. Provider business mailing address

2085 FRONTIS PLAZA BLVD FL 3
WINSTON SALEM NC
27103-5614
US

V. Phone/Fax

Practice location:
  • Phone: 980-960-0526
  • Fax:
Mailing address:
  • Phone: 336-277-8755
  • Fax: 336-277-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JODY MORRIS
Title or Position: VP OPS & NEW DEVELOPMENT
Credential:
Phone: 919-497-8401