| Organization Name: | WEST FORSYTH PAIN MANAGEMENT |
| NPI Number: | 1053692079 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMANDA ANNE ZIMMERMAN (PHYSICIAN ASSISTANT) |
| Mailing Address: | 2554 Lewisville Clemmons Rd Suite 211 Clemmons |
| State: | NC US |
| Postal Code: | 270128110 |
| Phone Number: | 3367409444 |
| Fax Number: | 3367409445 |
| NPI Enumeration Date: | 09/03/2011 |
| NPI Last Update Date: | 09/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 101887 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |