Provider Demographics
NPI:1598717001
Name:NOVANT HEALTH
Entity Type:Organization
Organization Name:NOVANT HEALTH
Other - Org Name:FORSYTH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-718-5775
Mailing Address - Street 1:4236 SHERLIE WEAVIL RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6506
Mailing Address - Country:US
Mailing Address - Phone:336-769-3745
Mailing Address - Fax:
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-5777
Practice Address - Fax:336-718-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1596282N00000X, 283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC340014Medicare ID - Type Unspecified