# FORSYTH MEMORIAL HOSPITAL, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Walkertown Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366400269
- **Authorized official:** GEOFFREY K GARDNER (VP FINACE)
- **Authorized official phone:** (704) 384-9144

## Contact information

- **Practice address:** 2800 DARROW RD, WALKERTOWN, NC 27051-9206
- **Practice address phone:** (336) 595-3699
- **Practice address fax:** (336) 595-3193
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (336) 595-3699
- **Mailing address fax:** (336) 595-3193

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 11/29/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 890218L | — | NC |
| 01 | — | CA1315 | RAILROAD MEDICARE | NC |