| Optimum Life Wellness Llc | |
|
620 Colonial Park Dr Ste 300 Roswell GA 30075-3839 | |
| (404) 609-4912 | |
| (404) 868-9499 |
| Full Name | Optimum Life Wellness Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 620 Colonial Park Dr Ste 300, Roswell, Georgia |
| Authorized Official Name and Position | Bakari E Vickerson (SOLE PROPRIETOR) |
| Authorized Official Contact | 4044237215 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimum Life Wellness Llc 620 Colonial Park Dr Ste 300 Roswell GA 30075-3839 Ph: (404) 609-4912 | Optimum Life Wellness Llc 620 Colonial Park Dr Ste 300 Roswell GA 30075-3839 Ph: (404) 609-4912 |
| NPI Number | 1396199238 |
|---|---|
| Provider Enumeration Date | 04/18/2016 |
| Last Update Date | 07/03/2025 |
| Certification Date | 07/03/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396199238 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 066914 (Georgia) | Primary |
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