Healthcare Provider Details

I. General information

NPI: 1053756577
Provider Name (Legal Business Name): JAMES RUSSELL BATEMAN III MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TREY BATEMAN MD

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

PO BOX 780125
PHILADELPHIA PA
19178-0125
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2255
  • Fax:
Mailing address:
  • Phone: 804-922-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number2018-01310
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2018-01310
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number0101284805
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: