Provider Demographics
NPI:1558631176
Name:AGAPE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:AGAPE FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:BEVERLY
Authorized Official - Last Name:DURAND-MITCHELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-368-5117
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36504-0650
Mailing Address - Country:US
Mailing Address - Phone:251-368-5117
Mailing Address - Fax:251-368-4191
Practice Address - Street 1:706 E LAUREL ST
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-3114
Practice Address - Country:US
Practice Address - Phone:251-368-5117
Practice Address - Fax:251-368-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051559714Medicaid
AL51006738OtherBCBS
ALH95529Medicare UPIN
AL051559714Medicaid