Provider Demographics
NPI:1790226546
Name:ELITE HYDRATION CENTER
Entity Type:Organization
Organization Name:ELITE HYDRATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:404-935-2189
Mailing Address - Street 1:245 N HIGHLAND AVE NE
Mailing Address - Street 2:STE 230-451
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1936
Mailing Address - Country:US
Mailing Address - Phone:404-935-2189
Mailing Address - Fax:
Practice Address - Street 1:4200 NORTHSIDE PKWY NW BLDG 8
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3007
Practice Address - Country:US
Practice Address - Phone:404-935-2189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy