Provider Demographics
NPI:1417696675
Name:FRYZEL, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FRYZEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 WILLIAMS CIR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1344
Mailing Address - Country:US
Mailing Address - Phone:678-876-4224
Mailing Address - Fax:
Practice Address - Street 1:1206 WILLIAMS CIR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1344
Practice Address - Country:US
Practice Address - Phone:678-876-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8051225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist