| Name: | AGAPE Family Medicine, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 04 Jun 2007 (17 years ago) |
| Entity Number: | 000-497-275 |
| Register Number: | 000497275 |
| County: | Escambia |
| Place of Formation: | Escambia County |
| Principal Address: | ATMORE, AL |
| Registered Office Street Address: | 630 AIRPORT RDATMORE, AL 36502 |
| Registered Office Street Address ZIP Code: | 36502 |
Activities
PROFESSIONAL MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558631176 | 2012-01-12 | 2012-03-13 | PO BOX 650, ATMORE, AL, 365040650, US | 706 E LAUREL ST, ATMORE, AL, 365023114, US | |||||||||||||||||||||||||||||||
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| Phone | +1 251-368-5117 |
| Fax | 2513684191 |
Authorized person
| Name | DR. PRISCILLA BEVERLY DURAND-MITCHELLE |
| Role | OWNER/PHYSICIAN |
| Phone | 2513685117 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 25566 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051559714 |
| State | AL |
| Issuer | BCBS |
| Number | 51006738 |
| State | AL |
| Name | Role |
|---|---|
| MITCHELLE-DURAND, PRISCILLA B | Agent |
| Name | Role |
|---|---|
| DURAND-MITCHELLE, PRISCILLA B | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
