Healthcare Provider Details

I. General information

NPI: 1891773115
Provider Name (Legal Business Name): PELHAM FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CREEKVIEW CT
GREENVILLE SC
29615-4800
US

IV. Provider business mailing address

25 CREEKVIEW CT
GREENVILLE SC
29615-4800
US

V. Phone/Fax

Practice location:
  • Phone: 864-297-7900
  • Fax: 864-458-8841
Mailing address:
  • Phone: 864-297-7900
  • Fax: 864-458-8841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LYN H HAMMOND
Title or Position: PRESIDENT
Credential: MD
Phone: 864-297-7900