Elite Medical Clinic, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

ELITE MEDICAL CLINIC, LLC

Practice address

1204 Ocilla Rd
Douglas, GA 31533-2220

Phone

(912) 393-5120

NPI assigned

Mar 21, 2022

Last updated

Mar 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Teresa Wilson, FNPC

Title

Owner

Phone

(912) 393-5120

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647820800000",
    "number": "1407505142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 OCILLA RD",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332220",
            "telephone_number": "912-393-5120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 OCILLA RD",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332220",
            "telephone_number": "912-393-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-21",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-393-5120",
        "authorized_official_credential": "FNPC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr. Dana E. Fender, D.M.D., P.C.
• Eddy Duncan, MD
• Dva Renal Healthcare Inc (Douglas Dialysis)
• Ear, Nose and Throat Clinic of Coffee Co.
• Jennifer Eason
• Anthony Forrest Ellis, PT
• Felicia Ellis, NP
• Emergency Physicians of Coffee County, LLC
• Envision Healthcare
• Katelin Ethridge, PHARMD

• Multi-Specialty Clinic/Center in Douglas, GA
• Providers in Douglas, GA by specialty
• Multi-Specialty Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.