Elite IV Hydration And Wellness
Clinic/Center in Mcdonough, GA. Organization (NPI-2).
NPI number1730843202
StatusActive
Last updated in NPPESJun 30, 2023
Details
- NPI
- 1730843202
- Entity type
- Organization (NPI-2)
- Legal business name
- Elite IV Hydration And Wellness
- Organization subpart
- No
- Enumeration date
- Oct 29, 2021
- Certification date
- Jun 30, 2023
- Last updated
- Jun 30, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
| 291U00000X | Clinical Medical Laboratory | – | – |
Practice location
823 Pavilion CtMcdonough, GA 30253-6666
Phone 404-965-5715
Mailing address
5916 East Lake PkwySuite 324
Mcdonough, GA 30253
Phone 706-399-4601
Authorized official
Tanika Ramsey Powell
Nurse Practitioner/Owner
7063994601
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