Healthcare Provider Details

I. General information

NPI: 1154271740
Provider Name (Legal Business Name): FORSYTH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N THIRD ST
MEBANE NC
27302-2405
US

IV. Provider business mailing address

2085 FRONTIS PLAZA BLVD
WINSTON SALEM NC
27103-5614
US

V. Phone/Fax

Practice location:
  • Phone: 336-962-5308
  • Fax: 336-900-1328
Mailing address:
  • Phone: 336-277-1611
  • Fax: 336-277-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number
License Number State

VIII. Authorized Official

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