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Organization

OPTIMUM LIFE WELLNESS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BAKARI E VICKERSON MD (SOLE PROPRIETOR)
(404) 423-7215
Entity
Organization

Contact information

Practice address
620 COLONIAL PARK DR STE 300, ROSWELL, GA 30075-3839
(404) 609-4912
(404) 868-9499
Mailing address
620 COLONIAL PARK DR STE 300, ROSWELL, GA 30075-3839
(404) 609-4912
(404) 868-9499

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
066914
GA

Other

Enumeration date
04/18/2016
Last updated
07/03/2025
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