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General NPI Number Information
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NPI Number | 1891609996
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Entity Type | Individual
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Provider Name | JAMES A. WISDOM NP
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Gender | Male
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 70 MEDICAL CENTER CIR STE 305
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City | FISHERSVILLE
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State | VA
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Zip | 22939-2273
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Country | US
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Telephone | 540-332-5747
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Fax |
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Provider Business Mailing Address
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Address Line | 112 BEAUREGARD DR
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City | STAUNTON
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State | VA
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Zip | 24401-9063
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Country | US
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Telephone | 714-232-2503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 0024198132
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License Number State | VA
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