Evaluation of groundwater quality and related health hazards is a prerequisite for taking preventive measures. The rural region of Telangana, India, has been selected for the present study to assess the sources and origins of inferior groundwater quality and to understand the human health risk zones for adults and children due to the consumption of nitrate ( NO 3 - )- and fluoride (F − )-contaminated groundwater for drinking purposes. Groundwater samples collected from the study region were determined for various chemical parameters. Groundwater quality was dominated by Na + and HCO 3 - ions. Piper’s diagram and bivariate plots indicated the carbonate water type and silicate weathering as a main factor and man-made contamination as a secondary factor controlling groundwater chemistry; hence, the groundwater quality in the study region is low. According to the Groundwater Quality Index (GQI) classification, 48.3% and 51.7% of the total study region are excellent (GQI: < 50) and good (GQI: 50 to 100) water quality types, respectively, for drinking purposes. However, NO 3 - ranged from 0.04 to 585 mg/L, exceeding the drinking water quality limit of 45 mg/L in 34% of the groundwater samples due to the effects of nitrogen fertilizers. This was supported by the relationship of NO 3 - with TDS, Na + , and Cl − . The F − content was from 0.22 to 5.41 mg/L, which exceeds the standard drinking water quality limit of 1.5 mg/L in 25% of the groundwater samples. The relationship of F − with pH, Ca 2+ , Na + , and HCO 3 - supports the weathering and dissolution of fluoride-rich minerals for high F − content in groundwater. They were further supported by a principal component analysis. The Health Risk Index (HRI) values ranged from 0.20 to 20.10 and 0.36 to 30.90 with a mean of 2.82 and 4.34 for adults and children, respectively. The mean intensity of HRI (> 1.0) was 1.37 times higher in children (5.70) than in adults (4.16) due to the differences in weight size and exposure time. With an acceptable limit of more than 1.0, the study divided the region into Northern Safe Health Zone (33.3% for adults and 28.1% for children) and Southern Unsafe Health Zone (66.7% for adults and 71.9% for children) based on the intensity of agricultural activity. Therefore, effective strategic measures such as safe drinking water, denitrification, defluoridation, rainwater harvesting techniques, sanitary facilities, and chemical fertilizer restrictions are recommended to improve human health and protect groundwater resources.