# STANLY MEDICAL SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Western Stanly Primary Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073594305
- **Authorized official:** DOUGLAS SCOTT FORTH (CEO)
- **Authorized official phone:** (704) 983-8756

## Contact information

- **Practice address:** 103 STANLY PKWY, SUITE B, LOCUST, NC 28097-7704
- **Practice address phone:** (704) 888-8581
- **Practice address fax:** (704) 888-8488
- **Mailing address:** 320 YADKIN ST, SUITE B, ALBEMARLE, NC 28001-3447
- **Mailing address phone:** (704) 982-0639
- **Mailing address fax:** (704) 983-6153

## Taxonomy

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

## Other

- **Enumeration date:** 11/14/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 89015AE | — | NC |