Provider Demographics
NPI:1184429284
Name:ELITE MEDICAL SOUTHEAST, LLC
Entity type:Organization
Organization Name:ELITE MEDICAL SOUTHEAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHASSITY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, NP-C
Authorized Official - Phone:662-922-2023
Mailing Address - Street 1:384 GOODMAN RD E # 127
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9522
Mailing Address - Country:US
Mailing Address - Phone:662-922-2023
Mailing Address - Fax:662-246-2034
Practice Address - Street 1:7165 SWINNEA RD STE 2
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6360
Practice Address - Country:US
Practice Address - Phone:662-922-2023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty