Provider Demographics
NPI:1013438928
Name:DAVIS, CLAYTON CAVANAUGH (DO)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:CAVANAUGH
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:CLAYTON
Other - Middle Name:CAVANAUGH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-1535
Mailing Address - Country:US
Mailing Address - Phone:276-439-1000
Mailing Address - Fax:
Practice Address - Street 1:100 15TH ST NW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1616
Practice Address - Country:US
Practice Address - Phone:276-439-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116030970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine