Provider Demographics
NPI:1194720417
Name:FRIZZELLE, JAMES THOMAS JR (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:FRIZZELLE
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 RIVERS BEND BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8632
Mailing Address - Country:US
Mailing Address - Phone:804-571-5000
Mailing Address - Fax:804-518-1314
Practice Address - Street 1:13038 RIVERS BEND RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2564
Practice Address - Country:US
Practice Address - Phone:804-526-5888
Practice Address - Fax:804-526-5401
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102298363A00000X
VA0110-004254363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291494800Medicaid
FLY05W9OtherBCBS
FLE8930YMedicare PIN