Healthcare Provider Details

I. General information

NPI: 1114332293
Provider Name (Legal Business Name): FORSYTH MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 VILLAGE MEDICAL CIR
CLEMMONS NC
27012-8004
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-893-2420
  • Fax: 336-893-2431
Mailing address:
  • Phone: 704-384-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEOFFREY KEITH GARDNER
Title or Position: VPFINANCE
Credential:
Phone: 704-384-7603