MEDICARE: WEST FORSYTH INTERNAL MEDICINE

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1841861457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST FORSYTH INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	1455 HAW CREEK CIR E STE 603
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-6576
Country	:	US
Telephone Number	:	770-415-2515
Fax Number	:	770-415-2515

Provider Business Practice Location Address
First Line	:	1455 HAW CREEK CIR E STE 603
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-6576
Country	:	US
Telephone Number	:	770-415-2515
Fax Number	:	770-415-2515

Authorized Official
Title or Position	:	CEO
Name	:	ALLISON SANTIZO
Credential	:	NP
Telephone Number	:	770-415-2515

Provider Enumeration Date	:	07/06/2021
Last Update Date	:	11/18/2024

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Directions to “WEST FORSYTH INTERNAL MEDICINE ” Practice Location

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