Healthcare Provider Details

I. General information

NPI: 1013226307
Provider Name (Legal Business Name): FORSYTH MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 LEXINGTON AVE SUITE B
THOMASVILLE NC
27360-3416
US

IV. Provider business mailing address

PO BOX 75216
CHARLOTTE NC
28275-0216
US

V. Phone/Fax

Practice location:
  • Phone: 336-481-1950
  • Fax: 336-277-8805
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHALA DAVIS
Title or Position: RCS MANAGER
Credential:
Phone: 704-303-7517