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Organization
FORSYTH MEMORIAL HOSPITAL INC
Active
Organization
FORSYTH MEMORIAL HOSPITAL INC
Active
Other names
Novant Health Clemmons Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (RCS MGR)
(704) 303-7517
Entity
Organization
Contact information
Practice address
6301 STADIUM DR, CLEMMONS, NC 27012-8766
(336) 766-6473
(336) 766-8909
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(704) 384-9144
(704) 417-1043
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015AA
BLUECROSS BLUESHIELD
NC
01
—
106
BLUE MEDICARE
NC
05
—
89015AA
—
NC
01
—
CA1315
RAILROAD MEDICARE
NC
Enumeration date
05/02/2006
Last updated
08/18/2021
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