# BALLANTYNE FAMILY MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376804971
- **Authorized official:** DR. RICHARD T. WYNN M.D. (PRESIDENT)
- **Authorized official phone:** (704) 208-4134

## Contact information

- **Practice address:** 16147 LANCASTER HWY, SUITE 140, CHARLOTTE, NC 28277-4782
- **Practice address phone:** (704) 208-4134
- **Practice address fax:** (704) 248-7845
- **Mailing address:** 16147 LANCASTER HWY, SUITE 140, CHARLOTTE, NC 28277-4782
- **Mailing address phone:** (704) 208-4134
- **Mailing address fax:** (704) 248-7845

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2011-01795 | NC | Yes |

## Other

- **Enumeration date:** 05/31/2012
- **Last updated:** 02/24/2016