NPI age
6 years
Enumerated 2019-12-16
● Active Type 2 · Organization
Ivydale Wellness Center Llc
Ivydale Wellness Center Llc is 1 of 1622 nurse practitioner organizations in Georgia.
Primary specialty
Nurse Practitioner
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Agomessou
Owner
Last NPPES update
2026-01-15
Source: monthly bulk 2026-05
How this organization compares
Across 1622 active nurse practitioner providers in Georgia.
NPI age
6 years
↑ 2 yr above median
Practice locations
1
0 secondary on file
Subspecialties
1
In the 37% of peers with subspecialties
NPI lifetime · 2019 → 2026
2019-12Enumerated in NPPES
2019
2026
Where they practice
Primary practice location
361 Resource Pkwy
Winder, GA 306808364
Mailing address
881 Ivydale Ln
Lawrenceville, GA 300457818
Authorized official
Ablavi Adodo Agomessou
Owner
📞 4048198701
Individual providers at this organization
1 individual provider on file at this primary practice address.
- Brendalyne Tamba, FNP Nurse Practitioner NPI 1053925107
Specialties
-
Nurse Practitioner PrimaryDefinition to come...
-
Nurse PractitionerDefinition to come...
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Ivydale Wellness Center
-
Ivydale Wellness Center
Practice context
Multi-provider organization. 1 individual provider on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.