Organization
BALLANTYNE EMERGENCY PHYSICIANS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM H LARSEN (DIRECTOR OF CREDENTIALING)
(770) 874-5400
Entity
Organization
Contact information
Practice address
11516 PROVIDENCE RD, CHARLOTTE, NC 28277-2691
(704) 667-0370
Mailing address
5665 NEW NORTHSIDE DR STE 320, ATLANTA, GA 30328-5834
(770) 874-5400
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
01/23/2020
Last updated
06/17/2020
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