Healthcare Provider Details

I. General information

NPI: 1205368230
Provider Name (Legal Business Name): CAMERON THOMASSON APRN, AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMERON MANESS APRN, AGACNP

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N SUMTER ST STE 410
SUMTER SC
29150
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-9000
  • Fax:
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number20880
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number20880
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: