# FORSYTH MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Queen City Ear Nose and Throat
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396624078
- **Authorized official:** JODY MORRIS (VP OPS AND NEW DEVELOPMENT)
- **Authorized official phone:** (919) 497-8401

## Contact information

- **Practice address:** 8924 BLAKENEY PROFESSIONAL DR, CHARLOTTE, NC 28277-6660
- **Practice address phone:** (704) 703-1080
- **Practice address fax:** (704) 703-1090
- **Mailing address:** 2085 FRONTIS PLAZA BLVD FL 3, WINSTON SALEM, NC 27103-5614
- **Mailing address phone:** (336) 277-1611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | Yes |
| 207Y00000X | Otolaryngology Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/28/2025
- **Last updated:** 08/28/2025