# FORSYTH MEMORIAL HOSPITAL, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NH Bermuda Run Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053812875
- **Authorized official:** SHALA DAVIS (MANGER RCS)
- **Authorized official phone:** (704) 316-7845

## Contact information

- **Practice address:** 5380 US HIGHWAY 158 STE 110, ADVANCE, NC 27006-6974
- **Practice address phone:** (336) 893-3210
- **Mailing address:** PO BOX 751803, CHARLOTTE, NC 28275-1803

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/27/2018
- **Last updated:** 02/27/2018