# AGAPE CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922720333
- **Authorized official:** MR. JOHN ERNEST WILLIAMS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (928) 459-3400

## Contact information

- **Practice address:** 2140 W 24TH ST STE B, YUMA, AZ 85364-8877
- **Practice address phone:** (928) 459-3400
- **Practice address fax:** (928) 459-2077
- **Mailing address:** 2140 W 24TH ST STE B, YUMA, AZ 85364-8877
- **Mailing address phone:** (928) 503-4060
- **Mailing address fax:** (928) 459-2077

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/13/2022
- **Last updated:** 09/13/2022