Healthcare Provider Details

I. General information

NPI: 1760936819
Provider Name (Legal Business Name): JAMES CLAYTON BAVINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2016
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DIXON ST STE 204
FREDERICKSBURG VA
22401-7231
US

IV. Provider business mailing address

1500 DIXON ST STE 204
FREDERICKSBURG VA
22401-7231
US

V. Phone/Fax

Practice location:
  • Phone: 540-654-5333
  • Fax: 540-654-5334
Mailing address:
  • Phone: 540-654-5333
  • Fax: 540-654-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101279865
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: