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General NPI Number Information
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NPI Number | 1558631176
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Entity Type | Organization
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Legal Business Name | AGAPE FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 706 E LAUREL ST
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City | ATMORE
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State | AL
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Zip | 36502-3114
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Country | US
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Telephone | 251-368-5117
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Fax | 251-368-4191
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Provider Business Mailing Address
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Address Line | PO BOX 650
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City | ATMORE
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State | AL
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Zip | 36504-0650
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Country | US
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Telephone | 251-368-5117
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Fax | 251-368-4191
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. PRISCILLA BEVERLY DURAND-MITCHELLE
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Credential | M.D.
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Telephone | 251-368-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25566
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License Number State | AL
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