Forsyth Community PCC LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FORSYTH COMMUNITY PCC LLC

Practice address

650 Highland Ave Ste 120
Winston Salem, NC 27101-4304

Phone

(336) 718-4770

Fax

(336) 718-4779

NPI assigned

May 23, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Leea Jeanine Walton

Title

RCS Manager

Phone

(704) 316-6081

Specialties & licenses 1

Addresses

Other names 1

• Highland Avenue Primary Care Clinic Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1730670951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603582",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HIGHLAND AVE STE 120",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271014304",
            "telephone_number": "336-718-4770",
            "fax_number": "336-718-4779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORSYTH COMMUNITY PCC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-23",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Highland Avenue Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pamela Jean Forrester, P-LCSW
• Forsyth Acoustics Inc
• Forsyth Bone Density Imaging Center
• Forsyth Cardiac & Vascular Surgeons, P.a.
• Forsyth Cardiology Associates, PA
• Forsyth County
• Forsyth County
• Forsyth County North Carolina
• Forsyth County North Carolina
• Forsyth County Public Health Cleveland Ave Dental Center

• All providers in Winston Salem, NC
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.