34D2121342 CLIA NUMBER - CAROLINA ADVANCED WELLNESS, PLLC

Laboratory Demographics

CLIA Number: 34D2121342

Facility Name: CAROLINA ADVANCED WELLNESS, PLLC

Facility Address:
9930 KINCEY AVE, SUITE 175
HUNTERSVILLE, NC
ZIP 28078
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Facility Phone Number: 704 820-4197

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1497376370

Taxonomy: 213ES0103X - Podiatrist

CLIA Record

Field Name	Field Value
CLIA Number	34D2121342
LAB Type	Physician Office
Facility Name	CAROLINA ADVANCED WELLNESS, PLLC
Street	9930 KINCEY AVE, SUITE 175
City	HUNTERSVILLE
State	NC
ZIP	28078
Phone	704 820-4197
CertificateType	4
CertificateEffectiveDate	11/3/2022
CertificateExpirationDate	11/2/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024