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AGAPE Family Medicine, LLC

Details

Name: AGAPE Family Medicine, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 04 Jun 2007 (17 years ago) (Companies founded in June 2007)
Entity Number: 000-497-275
Register Number: 000497275
ZIP code: 36502 (Companies in Escambia, 36502)
County: Escambia
Place of Formation: Escambia County
Principal Address: ATMORE, AL
Registered Office Street Address: 630 AIRPORT RDATMORE, AL 36502

Activities PROFESSIONAL MEDICAL SERVICES

National Provider Identifier

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

Contacts

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

Agent

Name Role
MITCHELLE-DURAND, PRISCILLA B Agent

Member

Name Role
DURAND-MITCHELLE, PRISCILLA B Member

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State