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General NPI Number Information
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NPI Number | 1265644025
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Entity Type | Organization
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Legal Business Name | AGAPE FAMILY MEDICINE & PEDIATRICS, P.A.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 218 OLD MOCKSVILLE RD
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City | STATESVILLE
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State | NC
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Zip | 28625-1930
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Country | US
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Telephone | 828-994-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 4926 BROOKRIDGE DR NE
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City | HICKORY
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State | NC
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Zip | 28601-8791
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Country | US
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Telephone | 828-994-0990
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Fax | 828-994-0995
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL HOWARD BRIDGES
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Credential | MD
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Telephone | 828-994-0990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 9600463
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License Number State | NC
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