Healthcare Provider Details

I. General information

NPI: 1871595082
Provider Name (Legal Business Name): CLARENCE HENRY BEAVERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E MEADOW RD STE 1
EDEN NC
27288-3469
US

IV. Provider business mailing address

PO BOX 1693
BRYSON CITY NC
28713-1693
US

V. Phone/Fax

Practice location:
  • Phone: 336-627-3194
  • Fax: 336-627-3208
Mailing address:
  • Phone: 336-967-0004
  • Fax: 828-538-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number39543
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39543
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: