Provider Demographics
NPI:1902122625
Name:FORSYTH MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:FORSYTH MEDICAL GROUP, LLC
Other - Org Name:FORSYTH PEDIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & COO OF NMG
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-277-2421
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-4820
Mailing Address - Fax:
Practice Address - Street 1:2205 OAK RIDGE RD
Practice Address - Street 2:SUITE AA-BB
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-8728
Practice Address - Country:US
Practice Address - Phone:336-644-0994
Practice Address - Fax:336-644-0997
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORSYTH MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-20
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty