Organization
CHESTERFIELD CLINIC CORP
Active
Parent organization
CHESTERFIELD CLINIC CORP
Other names
Hometown Family Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHESTERFIELD CLINIC CORP
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
715 S DOCTORS DR, SUITE B, CHERAW, SC 29520-7113
(843) 537-6557
Mailing address
715 S DOCTORS DR, SUITE B, CHERAW, SC 29520-7113
(843) 537-6557
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4513
—
SC
Enumeration date
03/16/2006
Last updated
09/24/2007
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