Healthcare Provider Details

I. General information

NPI: 1851188569
Provider Name (Legal Business Name): FORSYTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SUNDAY DR STE 309
RALEIGH NC
27607-5254
US

IV. Provider business mailing address

2085 FRONTIS PLAZA BLVD FL 3
WINSTON SALEM NC
27103-5614
US

V. Phone/Fax

Practice location:
  • Phone: 984-261-1560
  • Fax: 984-259-0156
Mailing address:
  • Phone: 336-277-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

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