Provider Demographics
NPI:1396899498
Name:FORSYTH COUNTY NORTH CAROLINA
Entity type:Organization
Organization Name:FORSYTH COUNTY NORTH CAROLINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:B
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-703-3099
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0686
Mailing Address - Country:US
Mailing Address - Phone:336-703-3117
Mailing Address - Fax:336-727-8062
Practice Address - Street 1:799 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4206
Practice Address - Country:US
Practice Address - Phone:336-703-3117
Practice Address - Fax:336-727-8062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORSYTH COUNTY NORTH CAROLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408318Medicaid