| Ivydale Wellness Center Llc | |
|
361 Resource Pkwy Winder GA 30680-8364 | |
| (770) 291-0419 | |
| Not Available |
| Full Name | Ivydale Wellness Center Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 361 Resource Pkwy, Winder, Georgia |
| Authorized Official Name and Position | Ablavi Adodo Agomessou (PMHNP-C) |
| Authorized Official Contact | 4048198701 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivydale Wellness Center Llc 881 Ivydale Ln Lawrenceville GA 30045-7818 Ph: (404) 819-8701 | Ivydale Wellness Center Llc 361 Resource Pkwy Winder GA 30680-8364 Ph: (770) 291-0419 |
| NPI Number | 1326653783 |
|---|---|
| Provider Enumeration Date | 09/12/2020 |
| Last Update Date | 09/12/2020 |
| Certification Date | 09/12/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326653783 | NPI | - | NPPES |
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