Ivydale Wellness Center LLC
NPI 1659919066ActiveOrganization· Nurse Practitioner, Psych/Mental Health· Winder, GA
Nurse Practitioner, Psych/Mental Health in Winder, Georgia, registered in NPPES in December 2019. The authorized official on file is Ablavi Adodo Agomessou, Owner. Enrolled in Medicare as part b supplier - clinic/group practice and part b supplier - clinic/group practice.
Overview
| NPI | 1659919066 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 16, 2019 |
| Last updated in NPPES | Jan 15, 2026 |
| Certified by provider | Jan 15, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Psych/Mental Health Primary | 363LP0808X | — | — |
| Nurse Practitioner, Family | 363LF0000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (GA); Part B Supplier - Clinic/Group Practice (NY) |
|---|
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