Healthcare Provider Details

I. General information

NPI: 1598723488
Provider Name (Legal Business Name): FORSYTH MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 W LAKE DR
MOUNT AIRY NC
27030-2157
US

IV. Provider business mailing address

1718 E 4TH ST SUITE 902
CHARLOTTE NC
28204-3261
US

V. Phone/Fax

Practice location:
  • Phone: 336-719-6100
  • Fax: 336-719-2313
Mailing address:
  • Phone: 336-719-6100
  • Fax: 336-719-2313

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 Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY LINDSAY
Title or Position: PRESIDENT OF FMC
Credential:
Phone: 336-718-2056