MEDICARE: ABLAVI AGOMESSOU APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	42127	GA
2	363LF0000X	Family Nurse Practitioner	42127	GA

General Provider Information

NPI Number	:	1164885778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABLAVI AGOMESSOU APRN

Provider Business Mailing Address
First Line	:	881 IVYDALE LN
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-7818
Country	:	US
Telephone Number	:	404-819-8701
Fax Number	:

Provider Business Practice Location Address
First Line	:	881 IVYDALE LN
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-7818
Country	:	US
Telephone Number	:	404-819-8701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	01/15/2026

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Directions to “ ABLAVI AGOMESSOU APRN” Practice Location

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