| NPI | 1659919066 |
|---|---|
| Doing Business As | IVYDALE WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | ABLAVI ADODO AGOMESSOU Nurse Practitioner 404-819-8701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 363LF0000X Nurse Practitioner, Family | |
| 208D00000X General Practice | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2020-10-27 |