# IV HYDRATION HEALTH & WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063294155
- **Authorized official:** SHACARYA KATORIA JACKSON NP (OWNER)
- **Authorized official phone:** (478) 342-2400

## Contact information

- **Practice address:** 617 CHERRY ST STE A, MACON, GA 31201-2880
- **Practice address phone:** (478) 342-2400
- **Mailing address:** 6711 CHRISWOOD DR, MACON, GA 31216-6721
- **Mailing address phone:** (478) 342-2400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/16/2023
- **Last updated:** 10/16/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1982317764 | — | GA |