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IVYDALE WELLNESS CENTER LLC
NPI 1326653783
Community/Behavioral Health in Winder, GA

Active since September 12, 2020CLIA 11D2178274 · Waiver
361 RESOURCE PKWY, WINDER, GA 30680(770) 291-0419 Get Directions Write a Review

NPPES record last updated: September 12, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ivydale Wellness Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IVYDALE WELLNESS CENTER LLC (NPI 1326653783), doing business as Ivydale Wellness Clinic, is a healthcare organization registered as a community/behavioral health in Winder, Georgia and active in the NPI registry since September 2020. The organization holds a CLIA Waiver certificate valid through January 29, 2028 and lists Ablavi Adodo Agomessou, Pmhnp-c, as its authorized official.

NPPES Registry Identity

NPI1326653783
Entity TypeOrganization
Primary Taxonomy251S00000X
Legal Business NameIVYDALE WELLNESS CENTER LLC
Location Address361 RESOURCE PKWYWinder, GA 30680-8364
Mailing Address881 Ivydale LnLawrenceville, GA 30045-7818 · (404) 819-8701
Phone(770) 291-0419
Organization SubpartYesParent: 19137243
Authorized OfficialAblavi Adodo AgomessouPmhnp-c · (404) 819-8701
Enumeration DateSeptember 12, 2020
NPPES CertifiedSeptember 12, 2020
✔ NPI 1326653783 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCommunity/Behavioral HealthAgencies
Taxonomy Code251S00000X
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X
Also ListedClinical Nurse Specialist · Psychiatric/Mental Health, GeropsychiatricTaxonomy 364SP0813X
361 RESOURCE PKWY, Winder, GA 30680
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Other Names 1

Doing Business AsIvydale Wellness Clinic

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2178274

Ivydale Wellness Center · Lawrenceville, GA
Active · expires Jan 29, 2028
CLIA Number11D2178274
Laboratory TypePractitioner Other
Certificate Effective DateJanuary 30, 2026
Certificate Expiration DateJanuary 29, 2028
Laboratory DirectorAblavi A. Agomessou
Laboratory Phone(404) 819-8701
Laboratory LocationIvydale Wellness Center881 Ivydale Lane, Lawrenceville, GA 30045
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRENDALYNE FACIA TAMBA FNP
Nurse Practitioner (Family)
361 RESOURCE PKWY
WINDER, GA 30680
Barrow County (770) 291-0419
IVYDALE WELLNESS CENTER LLC
Nurse Practitioner (Psychiatric/Mental Health)
361 RESOURCE PKWY
WINDER, GA 30680
Barrow County (770) 291-0419

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ivydale Wellness Center LLC's NPI number?

The NPI number for Ivydale Wellness Center LLC is 1326653783. It was assigned to this organization in the NPPES registry on September 12, 2020. The provider is doing business as Ivydale Wellness Clinic.

Where is Ivydale Wellness Center LLC located?

Ivydale Wellness Center LLC is located at 361 Resource Pkwy, Winder, GA 30680. The listed phone number is (770) 291-0419.

What is Ivydale Wellness Center LLC's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Does Ivydale Wellness Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2178274) is associated with this NPI, valid through January 29, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ivydale Wellness Center LLC was last updated on September 12, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.