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
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/16/2019
Last updated
01/15/2026
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