MEDICARE: AGAPE MEDICAL SUPPLY & DURABLE MEDICAL EQUIPMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1013161686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE MEDICAL SUPPLY & DURABLE MEDICAL EQUIPMENT

Provider Business Mailing Address
First Line	:	2950 STONE HOGAN RD
Second Line	:	SUITE 106
City	:	ATLANTA
State	:	GA
Zip	:	30331-2837
Country	:	US
Telephone Number	:	404-310-0809
Fax Number	:	404-696-9826

Provider Business Practice Location Address
First Line	:	2950 STONE HOGAN RD
Second Line	:	SUITE 106
City	:	ATLANTA
State	:	GA
Zip	:	30331-2837
Country	:	US
Telephone Number	:	404-310-0803
Fax Number	:	404-696-9826

Authorized Official
Title or Position	:	CFO
Name	:	MS. MARILYN E FRANKS
Credential	:
Telephone Number	:	404-210-9371

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	11/10/2008

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