Healthcare Provider Details

I. General information

NPI: 1336317593
Provider Name (Legal Business Name): JAMES L FLOYD JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128A PROFESSIONAL PARK PLACE AGAPE PHYSICIANS CARE
CONWAY SC
29526-9260
US

IV. Provider business mailing address

1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC., DBA AGAPE PHYSICIANS CARE
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 843-914-1057
  • Fax: 843-914-1058
Mailing address:
  • Phone: 803-454-0365
  • Fax: 803-404-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10343
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: