34D2159317 CLIA NUMBER - GESTALT PAIN CONSULTANTS

Laboratory Demographics

  • CLIA Code: 34D2159317
  • Facility Name: GESTALT PAIN CONSULTANTS
  • Facility Address: 10450 PARK ROAD SUITE 100
    CHARLOTTE, NC
    ZIP 28210
  • Facility Phone: 704 526-0091
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AKANDE A. ADEWUNMI
  • NPI Number: 1447726989
  • Taxonomy: 208VP0014X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D2159317
LAB Type Physician Office
Facility Name GESTALT PAIN CONSULTANTS
Street 10450 PARK ROAD SUITE 100
City CHARLOTTE
State NC
ZIP 28210
Phone 704 526-0091
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Physician Office
Lab Director AKANDE A. ADEWUNMI

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