MEDICARE: AGC WORLDWIDE LLC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1700311123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGC WORLDWIDE LLC

Provider Business Mailing Address
First Line	:	1100 KINGS RD UNIT 41645
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-7703
Country	:	US
Telephone Number	:	904-993-6101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 KINGS RD UNIT 41645
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-7703
Country	:	US
Telephone Number	:	904-993-6101
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SHERELL C EDWARDS
Credential	:
Telephone Number	:	904-993-6101

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	04/24/2017

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Directions to “AGC WORLDWIDE LLC ” Practice Location

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