Optimum Life Wellness LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

066914 Issued in GA

Legal business name

OPTIMUM LIFE WELLNESS LLC

Practice address

620 Colonial Park Dr Ste 300
Roswell, GA 30075-3839

Phone

(404) 609-4912

Fax

(404) 868-9499

NPI assigned

Apr 18, 2016

Last updated

Jul 3, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bakari E Vickerson, MDNPI 1437310380

Title

Sole Proprietor

Phone

(404) 423-7215

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bakari Eugene Vickerson, M.D.

  • Psychiatry Physician
  • Roswell, GA
  • NPI 1437310380
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751500800000",
    "number": "1396199238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 COLONIAL PARK DR STE 300",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753839",
            "telephone_number": "404-609-4912",
            "fax_number": "404-868-9499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 COLONIAL PARK DR STE 300",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753839",
            "telephone_number": "404-609-4912",
            "fax_number": "404-868-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM LIFE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-18",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A",
        "authorized_official_last_name": "VICKERSON",
        "authorized_official_first_name": "BAKARI",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "404-423-7215",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "066914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Savannah Christine Ooten, PT
• Opa Home Care, LLC
• Opa Hospice, LLC
• Open MRI of Georgia, Inc (MRI & Imaging of Georgia-North Fulton)
• Optimal Hearing Systems, LLC
• Marie Orff, PHARMD
• Oriental Acupuncture Center Inc
• Cherronica Ormond, MS, LPC
• Orthoxpress of Georgia (OrthoXpress of Roswell)
• Osama Saad Hindash

• Mental Health Clinic/Center (Including Community Mental Health Center) in Roswell, GA
• Providers in Roswell, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.