Healthcare Provider Details

I. General information

NPI: 1942958566
Provider Name (Legal Business Name): SHERNELL PETERSON CAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 VICK ST
ALBANY GA
31705-4088
US

IV. Provider business mailing address

315 VICK ST
ALBANY GA
31705-4088
US

V. Phone/Fax

Practice location:
  • Phone: 404-907-3291
  • Fax:
Mailing address:
  • Phone: 229-376-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW012782
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: