Healthcare Provider Details

I. General information

NPI: 1043690522
Provider Name (Legal Business Name): FORSYTH MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 ROCKFORD ST SUITE 1400
MOUNT AIRY NC
27030-6587
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-719-0398
  • Fax: 336-719-0494
Mailing address:
  • Phone: 336-719-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GEOFFERY GARDNER
Title or Position: VP OF FINANCE
Credential:
Phone: 336-719-0398