Healthcare Provider Details

I. General information

NPI: 1891609996
Provider Name (Legal Business Name): JAMES A. WISDOM NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEDICAL CENTER CIR STE 305
FISHERSVILLE VA
22939-2273
US

IV. Provider business mailing address

112 BEAUREGARD DR
STAUNTON VA
24401-9063
US

V. Phone/Fax

Practice location:
  • Phone: 540-332-5747
  • Fax:
Mailing address:
  • Phone: 714-232-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number0024198132
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: