Healthcare Provider Details

I. General information

NPI: 1104668003
Provider Name (Legal Business Name): CAMEO BLUNDSTONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 BROAD ST
AUGUSTA GA
30901-1214
US

IV. Provider business mailing address

1653 GARCIA DR APT A
FORT GORDON GA
30905-2817
US

V. Phone/Fax

Practice location:
  • Phone: 706-993-3829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: