Healthcare Provider Details

I. General information

NPI: 1518724285
Provider Name (Legal Business Name): HOMETOWN PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N RAILROAD AVE
LAMAR SC
29069-9727
US

IV. Provider business mailing address

105 N RAILROAD AVE
LAMAR SC
29069-9727
US

V. Phone/Fax

Practice location:
  • Phone: 843-345-6306
  • Fax:
Mailing address:
  • Phone: 843-420-9690
  • Fax: 843-543-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHERYL GAMBRELL
Title or Position: PARTNER
Credential: MD
Phone: 843-420-9690