Healthcare Provider Details

I. General information

NPI: 1811125909
Provider Name (Legal Business Name): CHERYL BRADLEY GAMBRELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL NICHOLE BRADLEY MD

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4568 SUNSET BLVD
LEXINGTON SC
29072-9250
US

IV. Provider business mailing address

105 N RAILROAD AVE
LAMAR SC
29069-9727
US

V. Phone/Fax

Practice location:
  • Phone: 803-520-5144
  • Fax: 803-462-0312
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 NumberMD40002
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101251800
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116021830
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: