NPIMap

Organization Active NPI

Elite IV Hydration and Wellness

  • Clinic/Center
  • McDonough, GA
National Provider Identifier
1730843202
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ELITE IV HYDRATION AND WELLNESS
Practice address
823 Pavilion CT
McDonough, GA 30253-6666
Phone
(404) 965-5715
NPI assigned
Oct 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tanika Ramsey Powell, DND, APRN, NP-CNPI 1356638746
Title
Nurse Practitioner/Owner
Phone
(706) 399-4601

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

823 Pavilion CT
McDonough, GA 30253-6666

Mailing address

5916 East Lake Pkwy
Suite 324
McDonough, GA 30253
Phone (706) 399-4601

Electronic endpoints 3

TypeEndpointUseAffiliation
Other URL Mcdonough
CONNECT URL Mcdonough
CONNECT URL Mcdonough Direct

National Provider Directory

National Provider Directory

Locations

821 Pavilion Ct
Ste D
McDonough, GA 30253

823 Pavilion Ct
McDonough, GA 30253
Phone (404) 965-5715

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1730843202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5916 EAST LAKE PKWY",
            "address_2": "SUITE 324",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "30253",
            "telephone_number": "706-399-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 PAVILION CT",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536666",
            "telephone_number": "404-965-5715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE IV HYDRATION AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-29",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "TANIKA",
        "authorized_official_middle_name": "RAMSEY",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "706-399-4601",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DND, APRN, NP-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Mcdonough",
            "affiliation": "N",
            "address_1": "5916 E Lake Pkwy Ste 324",
            "city": "McDonough",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302534802",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Mcdonough",
            "affiliation": "N",
            "address_1": "5916 E Lake Pkwy Ste 324",
            "city": "McDonough",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302534802",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Mcdonough",
            "affiliation": "N",
            "endpointDescription": "Mcdonough",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "823 Pavilion Ct",
            "city": "McDonough",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302536666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.