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Organization
IVYDALE WELLNESS CENTER LLC
Active
Organization
IVYDALE WELLNESS CENTER LLC
Active
Other names
Ivydale Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
ABLAVI ADODO AGOMESSOU (OWNER)
(404) 819-8701
Entity
Organization
Contact information
Practice address
361 RESOURCE PKWY, WINDER, GA 30680-8364
(770) 291-0419
Mailing address
881 IVYDALE LN, LAWRENCEVILLE, GA 30045-7818
(404) 819-8701
(240) 348-8500
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/16/2019
Last updated
01/15/2026
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