Agape Family Medicine, P.C.
Organization Active NPI Family Medicine Physician · Suwanee, GA
NPI 1174355663 · NPPES record last updated Aug 14, 2024
Key facts
- NPI
- 1174355663
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AGAPE FAMILY MEDICINE, P.C.
- Practice address
- 3265 Peachtree Pkwy
Suwanee, GA 30024-1036 - Phone
- (770) 876-5096
- NPI assigned
- Aug 14, 2024
- Organization subpart
- No
Authorized official
- Name
- Bede Soon Tae Cha, DO
- Title
- Ceo
- Phone
- (770) 876-5096
Practitioners 1
-
Bede Soon Tae Cha, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2313572 | Agape Family Medicine, PC | Certificate of waiver | Nov 3, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250130002880 | GA | Part B Supplier - Clinic/Group Practice | 5395274617 |
Receives reassigned benefits from 1 practitioner Practice locations: Suwanee, GA |
National Provider Directory
Locations
3265 Peachtree Pkwy
Suwanee, GA 30024
Phone (678) 967-3182
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
3265 Peachtree Pkwy
Suwanee, GA 30024-1036
Mailing address
3265 Peachtree Pkwy
Suwanee, GA 30024-1036
Phone (770) 876-5096
Other providers in Suwanee, GA
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- Advanced Gastroenterology Associates, LLC
- Advanced Medical Group, LLC
- Aegis Group Practice LLC
- Affinity Choice LLC
- Komal Agarwal
- Hibbah Ailya Agha
- Shalyn B Ahmadi
- Ahp of John'S Creek LLC
- Julius Olukayode Ajayi
All providers in Suwanee, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.