Healthcare Provider Details

I. General information

NPI: 1124522933
Provider Name (Legal Business Name): FORSYTH MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 NEW GARDEN RD STE 216
GREENSBORO NC
27410-2555
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-992-1351
  • Fax: 336-992-1361
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: GEOFFREY GARDNER
Title or Position: VP OF FINANCE
Credential:
Phone: 336-718-2078