Provider Demographics
NPI:1841861457
Name:WEST FORSYTH INTERNAL MEDICINE
Entity type:Organization
Organization Name:WEST FORSYTH INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIZO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:770-415-2515
Mailing Address - Street 1:1455 HAW CREEK CIR E STE 603
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6576
Mailing Address - Country:US
Mailing Address - Phone:770-415-2515
Mailing Address - Fax:770-415-2515
Practice Address - Street 1:1455 HAW CREEK CIR E STE 603
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6576
Practice Address - Country:US
Practice Address - Phone:770-415-2515
Practice Address - Fax:770-415-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care