34D2312489 CLIA NUMBER - PEACH STATE MEDICAL PRACTICE PC DBA KINDBODY OF NC

Laboratory Demographics

  • CLIA Code: 34D2312489
  • Facility Name: PEACH STATE MEDICAL PRACTICE PC DBA KINDBODY OF NC
  • Facility Address: 420 PROVIDENCE ROAD
    CHARLOTTE, NC
    ZIP 28207
  • Facility Phone: 980 242-5345
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KRISTEN CAIN
  • NPI Number: 1801544093
  • Taxonomy: 207VE0102X - Obstetrics & Gynecology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 34D2312489
LAB Type Physician Office
Facility Name PEACH STATE MEDICAL PRACTICE PC DBA KINDBODY OF NC
Street 420 PROVIDENCE ROAD
City CHARLOTTE
State NC
ZIP 28207
Phone 980 242-5345
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2024
Certificate Expiration Date 10/13/2026
Facility Type Physician Office
Lab Director KRISTEN CAIN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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