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General NPI Number Information
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NPI Number | 1174643852
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Entity Type | Organization
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Legal Business Name | AGAPE MEDICAL CLINIC PC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 1911 MILITARY ST S
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City | HAMILTON
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State | AL
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Zip | 35570
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Country | US
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Telephone | 205-952-9603
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Fax | 205-952-9661
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Provider Business Mailing Address
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Address Line | PO BOX 2282
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City | HAMILTON
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State | AL
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Zip | 35570
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Country | US
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Telephone | 205-952-9603
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Fax | 205-952-9661
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOROTHY E STIDHAM
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Credential | CRNP
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Telephone | 205-952-9603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1061751
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License Number State | AL
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