Provider Demographics
NPI:1366265449
Name:SOUTHERN ELITE CARE LLC
Entity type:Organization
Organization Name:SOUTHERN ELITE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TRONOLONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-238-3034
Mailing Address - Street 1:1499 KENNEDY RD STE B
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4177
Mailing Address - Country:US
Mailing Address - Phone:229-238-3034
Mailing Address - Fax:229-238-3027
Practice Address - Street 1:1499 KENNEDY RD STE B
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4177
Practice Address - Country:US
Practice Address - Phone:229-238-3034
Practice Address - Fax:229-238-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty