Provider Demographics
NPI:1023789625
Name:BEARD, CAMERON ALEXANDER
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:ALEXANDER
Last Name:BEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BLOSSOM ST APT A402
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-5208
Mailing Address - Country:US
Mailing Address - Phone:910-220-2639
Mailing Address - Fax:
Practice Address - Street 1:620 BLOSSOM ST APT A402
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-5208
Practice Address - Country:US
Practice Address - Phone:910-220-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer