Agape Family Medicine, LLC
Organization Active NPI Family Medicine Physician · Atmore, AL
NPI 1306026570 · NPPES record last updated Nov 5, 2007
Key facts
- NPI
- 1306026570
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 25566 (AL)
- Legal business name
- AGAPE FAMILY MEDICINE, LLC
- Practice address
- 706 E Laurel St
Atmore, AL 36502-3114 - Phone
- (251) 368-5117
- Fax
- (251) 368-4191
- NPI assigned
- Nov 5, 2007
- Organization subpart
- No
Authorized official
- Name
- Priscilla Beverly Durand-Mitchelle, M.D.
- Title
- Owner
- Phone
- (251) 368-5117
Corporate family (same tax ID) 1
Practitioners 2
-
Stacy A Upshaw, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120918000694 | AL | Part B Supplier - Clinic/Group Practice | 0648428516 |
Receives reassigned benefits from 1 practitioner Practice locations: Atmore, AL |
National Provider Directory
- Tax ID family
- Agape Family Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 25566 | AL | Yes |
Addresses
Primary practice location
706 E Laurel St
Atmore, AL 36502-3114
Mailing address
706 E Laurel St
Atmore, AL 36502-3114
Phone (251) 368-5117
Other providers in Atmore, AL
- A & C Onestop Educational Services
- Agape Family Medicine LLC
- Alabama Department of Public Health
- Alabama Em-I Medical Services PC
- Ams Atmore LLC
- Ann Marie Nowak LPC PC
- Astound Physical Therapy
All providers in Atmore, AL · Family Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2007. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.