1. Home
  2. Directory
  3. Georgia
  4. Roswell
  5. Clinic Center
  6. NPI Profile

OPTIMUM LIFE WELLNESS LLC
NPI 1396199238
Clinic/Center - Mental Health (Including Community Mental Health Center) in Roswell, GA

Active since April 18, 2016
620 COLONIAL PARK DR STE 300, ROSWELL, GA 30075(404) 609-4912(404) 868-9499 Get Directions Write a Review

NPPES record last updated: July 3, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Optimum Life Wellness Llc NPPES

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

OPTIMUM LIFE WELLNESS LLC (NPI 1396199238) is a healthcare organization registered as a mental health (including community mental health center) in Roswell, Georgia and active in the NPI registry since April 2016. The organization lists Bakari E Vickerson, Sole Proprietor, as its authorized official.

NPPES Registry Identity

NPI1396199238
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NameOPTIMUM LIFE WELLNESS LLC
Location Address620 COLONIAL PARK DR STE 300Roswell, GA 30075-3839
Mailing Address620 Colonial Park Dr Ste 300Roswell, GA 30075-3839 · (404) 609-4912 · Fax (404) 868-9499
Phone(404) 609-4912
Fax(404) 868-9499
Organization SubpartNo
Authorized OfficialBakari E VickersonSole Proprietor · (404) 423-7215
Enumeration DateApril 18, 2016
Last NPPES UpdateJuly 3, 2025
NPPES CertifiedJuly 3, 2025
✔ NPI 1396199238 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities
Taxonomy Code261QM0801X
License✔ Licensed in GA · 066914
620 COLONIAL PARK DR STE 300, Roswell, GA 30075
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Optimum Life Wellness Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Optimum Life Wellness LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Bakari Vickerson, M.D.
Psychiatry
NPI 1437310380
620 COLONIAL PARK DR STE 300
Roswell, GA 30075
(404) 609-4912
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Optimum Life Wellness LLC's NPI number?

The NPI number for Optimum Life Wellness LLC is 1396199238. It was assigned to this organization in the NPPES registry on April 18, 2016.

Where is Optimum Life Wellness LLC located?

Optimum Life Wellness LLC is located at 620 Colonial Park Dr Ste 300, Roswell, GA 30075. The listed phone number is (404) 609-4912.

What is Optimum Life Wellness LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Is Optimum Life Wellness LLC enrolled in Medicare?

Yes. Optimum Life Wellness LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Optimum Life Wellness LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Psychiatry) reassigns their Medicare billing to Optimum Life Wellness LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Optimum Life Wellness LLC was last updated on July 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.