Healthcare Provider Details

I. General information

NPI: 1275604647
Provider Name (Legal Business Name): CLINTON STEVEN BEVERLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 THOMSON DRIVE CENTRAL VIRGINIA SURGERY
LYNCHBURG VA
24501
US

IV. Provider business mailing address

1906 THOMSON DRIVE CENTRAL VIRGINIA SURGERY
LYNCHBURG VA
24501
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3933
  • Fax: 434-947-3988
Mailing address:
  • Phone: 434-947-3933
  • Fax: 434-947-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number054250
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: