Organization
ELITE MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA WILSON FNPC (OWNER)
(912) 393-5120
Entity
Organization
Contact information
Practice address
1204 OCILLA RD, DOUGLAS, GA 31533-2220
(912) 393-5120
Mailing address
1204 OCILLA RD, DOUGLAS, GA 31533-2220
(912) 393-5120
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
03/21/2022
Last updated
03/21/2022
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