Organization
BALLANTYNE FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD T. WYNN M.D. (PRESIDENT)
(704) 208-4134
Entity
Organization
Contact information
Practice address
16147 LANCASTER HWY, SUITE 140, CHARLOTTE, NC 28277-4782
(704) 208-4134
(704) 248-7845
Mailing address
16147 LANCASTER HWY, SUITE 140, CHARLOTTE, NC 28277-4782
(704) 208-4134
(704) 248-7845
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2011-01795
NC
Other
Enumeration date
05/31/2012
Last updated
02/24/2016
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