Healthcare Provider Details

I. General information

NPI: 1750429148
Provider Name (Legal Business Name): AGAPE' WELLNESS CENTER & WOUND CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLOT 6 CLIFTON HILL
KINGSHILL VI
00851
US

IV. Provider business mailing address

P. O. BOX 9281 RTE # 2
KINGSHILL VI
00851
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-0688
  • Fax:
Mailing address:
  • Phone: 340-778-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23898
License Number StateOK

VIII. Authorized Official

Name: DR. HUBERT H WATTY
Title or Position: OWNER / MANAGER
Credential: M.D
Phone: 918-869-3466