| NPI | 1326653783 |
|---|---|
| Doing Business As | IVYDALE WELLNESS CLINIC |
| Entity Type | Organization |
| Authorized Contact | ABLAVI ADODO AGOMESSOU Pmhnp C 404-819-8701 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 364SP0813X Clinical Nurse Specialist, Psych/Mental Health, Geropsychiatric | |
| Enumeration Date | 2020-09-12 |
| Last Update Date | 2020-09-12 |