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	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician

General Provider Information

NPI Number	:	1760295059
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	:	2323 CONCORD LAKE RD
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-2813
Country	:	US
Telephone Number	:	704-707-4120
Fax Number	:	704-706-9520

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

Provider Enumeration Date	:	01/30/2025
Last Update Date	:	07/21/2025

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