Provider Demographics
NPI:1083984298
Name:AGAPE FAMILY HEALTHCARE CLINIC
Entity Type:Organization
Organization Name:AGAPE FAMILY HEALTHCARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP CNM
Authorized Official - Phone:731-616-4468
Mailing Address - Street 1:2156 N HIGHLAND AVE # B108
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4915
Mailing Address - Country:US
Mailing Address - Phone:731-616-4468
Mailing Address - Fax:
Practice Address - Street 1:1124 WHITEHALL ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-8742
Practice Address - Country:US
Practice Address - Phone:731-616-4468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care