Healthcare Provider Details

I. General information

NPI: 1750907507
Provider Name (Legal Business Name): AGAPE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42598 STATE HIGHWAY 75
SNEAD AL
35952-6566
US

IV. Provider business mailing address

PO BOX 720
BOAZ AL
35957-0720
US

V. Phone/Fax

Practice location:
  • Phone: 205-466-9096
  • Fax:
Mailing address:
  • Phone: 256-840-5800
  • Fax: 256-840-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA L CLIFTON
Title or Position: OWNER
Credential: M.D.
Phone: 256-840-5800