# ELITE MEDICAL CLINIC, LLC

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

## Provider details

- **NPI number:** 1407505142
- **Authorized official:** TERESA WILSON FNPC (OWNER)
- **Authorized official phone:** (912) 393-5120

## Contact information

- **Practice address:** 1204 OCILLA RD, DOUGLAS, GA 31533-2220
- **Practice address phone:** (912) 393-5120
- **Mailing address:** 1204 OCILLA RD, DOUGLAS, GA 31533-2220
- **Mailing address phone:** (912) 393-5120

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/21/2022
- **Last updated:** 03/21/2022