MEDICARE: FORSYTH MEDICAL GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	133V00000X	Registered Dietitian
3	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1407669997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORSYTH MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	2085 FRONTIS PLAZA BLVD FL 3
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5614
Country	:	US
Telephone Number	:	336-277-8755
Fax Number	:	336-277-7701

Provider Business Practice Location Address
First Line	:	7006 SHANNON WILLOW RD STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1318
Country	:	US
Telephone Number	:	980-960-0526
Fax Number	:

Authorized Official
Title or Position	:	VP OPS & NEW DEVELOPMENT
Name	:	JODY MORRIS
Credential	:
Telephone Number	:	919-497-8401

Provider Enumeration Date	:	01/29/2025
Last Update Date	:	12/12/2025

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