Healthcare Provider Details

I. General information

NPI: 1508491796
Provider Name (Legal Business Name): JAMES WAGNER FRISBIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MANNING DR CB# 7235
CHAPEL HILL NC
27599-1544
US

IV. Provider business mailing address

19415 DEERFIELD AVE STE 112
LANSDOWNE VA
20176-8470
US

V. Phone/Fax

Practice location:
  • Phone: 919-843-9014
  • Fax:
Mailing address:
  • Phone: 703-724-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101288745
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: