34D1075060 CLIA NUMBER - AMITY MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 34D1075060
  • Facility Name: AMITY MEDICAL GROUP
  • Facility Address: 7945 NORTH TRYON ST, STE 112
    CHARLOTTE, NC
    ZIP 28262
  • Facility Phone: 704 503-6336
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KARLTON S. PETTIS MD
  • NPI Number: 1003301300
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 34D1075060
LAB Type Physician Office
Facility Name AMITY MEDICAL GROUP
Street 7945 NORTH TRYON ST, STE 112
City CHARLOTTE
State NC
ZIP 28262
Phone 704 503-6336
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2023
Certificate Expiration Date 10/11/2025
Facility Type Physician Office
Lab Director KARLTON S. PETTIS MD

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This page was last updated on: 9/29/2025