34D2053119 CLIA NUMBER - CRISWELL & CRISWELL PLASTIC SURGERY

Laboratory Demographics

  • CLIA Code: 34D2053119
  • Facility Name: CRISWELL & CRISWELL PLASTIC SURGERY
  • Facility Address: 14835 BALLANTYNE VILLAGE WAY SUITE 210
    CHARLOTTE, NC
    ZIP 28277
  • Facility Phone: 704 424-5050
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: BRYAN K. CRISWELL
  • NPI Number: 1710165915
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 34D2053119
LAB Type Ambulatory Surgery Center
Facility Name CRISWELL & CRISWELL PLASTIC SURGERY
Street 14835 BALLANTYNE VILLAGE WAY SUITE 210
City CHARLOTTE
State NC
ZIP 28277
Phone 704 424-5050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Ambulatory Surgery Center
Lab Director BRYAN K. CRISWELL

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