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Organization

FORSYTH MEMORIAL HOSPITAL INC

Active
Other names
Novant Health Forsyth Behavioral Health Outpatient
Organization subpart
No

Provider details

NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization

Contact information

Practice address
175 KIMEL PARK DR, SUITE 100, WINSTON SALEM, NC 27103-6951
(336) 277-1800
(336) 277-6981
Mailing address
PO BOX 75216, CHARLOTTE, NC 28275-0216
(704) 384-9144
(704) 417-1043

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
89012TT
BCBS GRP ID
NC
05
89012TT
NC
Enumeration date
01/23/2008
Last updated
07/10/2023
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