Provider Demographics
NPI:1205368230
Name:THOMASSON, CAMERON (APRN, AGACNP)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:THOMASSON
Suffix:
Gender:F
Credentials:APRN, AGACNP
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:
Other - Last Name:MANESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, AGACNP
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:115 N SUMTER ST STE 410
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-774-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20880363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCA4449988OtherMEDICARE
SCNP4529Medicaid