Provider Demographics
NPI:1811125909
Name:GAMBRELL, CHERYL BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:BRADLEY
Last Name:GAMBRELL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:NICHOLE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:105 N RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:SC
Mailing Address - Zip Code:29069-9727
Mailing Address - Country:US
Mailing Address - Phone:843-420-9690
Mailing Address - Fax:843-543-6393
Practice Address - Street 1:4568 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9250
Practice Address - Country:US
Practice Address - Phone:803-520-5144
Practice Address - Fax:803-462-0312
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD40002208000000X
VA0101251800208000000X
VA0116021830390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program