Provider Demographics
NPI:1376896845
Name:AGAPE INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:AGAPE INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DARAMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-426-2932
Mailing Address - Street 1:6080 S HULEN ST
Mailing Address - Street 2:STE 360 PMB 229
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2622
Mailing Address - Country:US
Mailing Address - Phone:864-426-2932
Mailing Address - Fax:
Practice Address - Street 1:6080 S HULEN ST
Practice Address - Street 2:STE 360 PMB 229
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-2622
Practice Address - Country:US
Practice Address - Phone:864-426-2932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4369174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty