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
—
—
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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