Organization
HYDR8ME IV LOUNGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETRINO PIERCE RN (OWNER)
(678) 832-8065
Entity
Organization
Contact information
Practice address
7824 HICKORY FLAT HWY STE 130, WOODSTOCK, GA 30188-6575
(678) 832-8065
(877) 599-6195
Mailing address
211 PAYTON PL, WOODSTOCK, GA 30188-3185
(678) 832-8065
(877) 599-6195
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
—
163WI0500X
Infusion Therapy Registered Nurse
—
—
251F00000X
Home Infusion Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
11/12/2025
Last updated
11/12/2025
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