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	License Number	License Number State
1	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1710866405
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	:	336-277-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	1994 WELLNESS BLVD STE 210
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-7768
Country	:	US
Telephone Number	:	704-703-1080
Fax Number	:	704-703-1090

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

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	08/28/2025

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