Provider Demographics
NPI:1275566093
Name:FORSYTHE, PHILLIP DAVID WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DAVID WESLEY
Last Name:FORSYTHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2019
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37116-2019
Mailing Address - Country:US
Mailing Address - Phone:615-860-8822
Mailing Address - Fax:615-865-7598
Practice Address - Street 1:355 NEW SHACKLE ISLAND RD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2300
Practice Address - Country:US
Practice Address - Phone:615-338-1200
Practice Address - Fax:615-338-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42833207R00000X
TNMD17300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA98442Medicare UPIN