Healthcare Provider Details

I. General information

NPI: 1497490676
Provider Name (Legal Business Name): LYONS HEART PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 07/14/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7623 WILSON BLVD
COLUMBIA SC
29203
US

IV. Provider business mailing address

7623 WILSON BLVD
COLUMBIA SC
29203-4385
US

V. Phone/Fax

Practice location:
  • Phone: 844-759-6647
  • Fax:
Mailing address:
  • Phone: 844-759-6647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHERRI LATOSHA MCCAIN
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 844-759-6647