# IVYDALE WELLNESS CENTER LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Ivydale Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659919066
- **Authorized official:** ABLAVI ADODO AGOMESSOU (OWNER)
- **Authorized official phone:** (404) 819-8701

## Contact information

- **Practice address:** 361 RESOURCE PKWY, WINDER, GA 30680-8364
- **Practice address phone:** (770) 291-0419
- **Mailing address:** 881 IVYDALE LN, LAWRENCEVILLE, GA 30045-7818
- **Mailing address phone:** (404) 819-8701
- **Mailing address fax:** (240) 348-8500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/16/2019
- **Last updated:** 01/15/2026