Healthcare Provider Details

I. General information

NPI: 1396624078
Provider Name (Legal Business Name): FORSYTH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8924 BLAKENEY PROFESSIONAL DR
CHARLOTTE NC
28277-6660
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 704-703-1080
  • Fax: 704-703-1090
Mailing address:
  • Phone: 336-277-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

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