| Southern Elite Care Llc | |
|
1499 Kennedy Rd Ste B Tifton GA 31794-4177 | |
| (229) 238-3034 | |
| (229) 238-3027 |
| Full Name | Southern Elite Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1499 Kennedy Rd Ste B, Tifton, Georgia |
| Authorized Official Name and Position | Jonathan W Tronolone (OWNER) |
| Authorized Official Contact | 2292383034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Elite Care Llc 1499 Kennedy Rd Ste B Tifton GA 31794-4177 Ph: (229) 238-3034 | Southern Elite Care Llc 1499 Kennedy Rd Ste B Tifton GA 31794-4177 Ph: (229) 238-3034 |
| NPI Number | 1366265449 |
|---|---|
| Provider Enumeration Date | 11/06/2024 |
| Last Update Date | 11/06/2024 |
| Medicare PECOS PAC ID | 6305375908 |
|---|---|
| Medicare Enrollment ID | O20250128001556 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366265449 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jonathan W Tronolone |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1376626432 PECOS PAC ID: 9537253950 Enrollment ID: I20090507000440 |
| Provider Name | Heath J Parrish |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932464542 PECOS PAC ID: 5294981916 Enrollment ID: I20120813000749 |
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