Organization
BALLANTYNE EMERGENCY PHYSICIANS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LARSEN (DIRECTOR OF CREDENTIALING)
(423) 605-5885
Entity
Organization
Contact information
Practice address
16035 JOHNSON ROAD, CHARLOTTE, NC 28277
(704) 667-0370
Mailing address
5665 NEW NORTHSIDE DR STE 320, ATLANTA, GA 30328-5834
(423) 605-5885
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
10/04/2023
Last updated
10/04/2023
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