Organization
FORSYTH PLASTIC SURGICAL ASSOC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ANDUSON FAGG MD (PRESIDENT)
(336) 765-8620
Entity
Organization
Contact information
Practice address
2901 MAPLEWOOD AVE, WINSTON SALEM, NC 27103
(336) 765-8620
(336) 768-6236
Mailing address
2901 MAPLEWOOD AVE, WINSTON SALEM, NC 27103
(336) 765-8620
(336) 768-6236
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
20000119979
NC
208200000X
Plastic Surgery Physician
200001205450
NC
208200000X
Plastic Surgery Physician
200001225739
NC
Other
Enumeration date
09/07/2006
Last updated
08/22/2020
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