Individual
O'SHANE LEMAR FORSYTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3519 CHELSEA MANOR DR, WINSTON SALEM, NC 27103-1585
(336) 501-4085
Mailing address
3519 CHELSEA MANOR DR, WINSTON SALEM, NC 27103-1585
(336) 501-4085
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
000030993837
NC
Other
Enumeration date
09/22/2019
Last updated
09/22/2019
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