Organization
ELITE IV HYDRATION AND WELLNESS
Active
Organization
ELITE IV HYDRATION AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANIKA RAMSEY POWELL DND, APRN, NP-C (NURSE PRACTITIONER/OWNER)
(706) 399-4601
Entity
Organization
Contact information
Practice address
823 PAVILION CT, MCDONOUGH, GA 30253-6666
(404) 965-5715
Mailing address
5916 EAST LAKE PKWY, SUITE 324, MCDONOUGH, GA 30253
(706) 399-4601
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
10/29/2021
Last updated
06/30/2023
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