Organization · Type 2 NPI

Ivydale Wellness Center LLC

Psychiatric/Mental Health Nurse Practitioner · Winder, GA

NPI number 1659919066 Active

Practice location

361 Resource Pkwy
Winder, GA 30680-8364

Call (770) 291-0419 Map

Mailing address

881 Ivydale Ln
Lawrenceville, GA 30045-7818

Specialties and licenses

Taxonomy	Code	License
Family Nurse Practitioner	363LF0000X	None listed
Psychiatric/Mental Health Nurse Practitioner Primary	363LP0808X	None listed

Psychiatric/Mental Health Nurse Practitioner: Definition to come...

2 other providers at this address

Ivydale Wellness Center LLCCommunity/Behavioral Health Agency Winder, GA NPI 1326653783
Brendalyne Facia Tamba, FNPFamily Nurse Practitioner Winder, GA NPI 1053925107

Other psychiatric/mental health nurse practitioner providers in Winder

Visionary Behavioral Health Services, LLCPsychiatric/Mental Health Nurse Practitioner Winder, GA NPI 1912751033

See all in Winder →

NPI record

NPI: 1659919066
Entity type: Organization (Type 2)
Issued: Dec 16, 2019
Last updated: Jan 15, 2026
Status: Active

Other names

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Ivydale Wellness Center · doing business as
Ivydale Wellness Center · doing business as

Authorized official

Ablavi Adodo Agomessou
Owner
(404) 819-8701

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1659919066

Ivydale Wellness Center LLC's National Provider Identifier is 1659919066, issued on Dec 16, 2019. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Winder, GA. The record was last updated on Jan 15, 2026.