Organization Active NPI

Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Winder, GA
National Provider Identifier
1033229059
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MEDLINK GEORGIA INC
Practice address
133 W Athens St
Winder, GA 30680-1786
Phone
(770) 867-6633
NPI assigned
Aug 30, 2006
Organization subpart
Yes
Parent organization
MEDLINK GEORGIA INCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
David Ward
Title
Ceo
Phone
(706) 788-3234

Corporate family (same tax ID) 45

Organizations that report the same tax identification number in the National Provider Directory.

View all 45

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Federally qualified health center certification: CCN 111870

Medicare enrollment files
Legal name
MEDLINK GEORGIA INC
Doing business as
MEDLINK WINDER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 25, 2003
Last certification
Feb 25, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 29, 1980 in GA
Enrollment address
133 W Athens St
Winder, GA 30680-1786

All disclosed owners & managing parties 13

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David Ward Individual Corporate OfficerCeo Aug 20, 2011
Fay Burnett Individual Corporate Director Jan 21, 2016
Bobby Berryman Individual Corporate DirectorBoard Member Feb 1, 1999
Marilyn Favors Individual Corporate DirectorBoard Member Mar 15, 2009
Albert Stone Individual Corporate DirectorBoard Member Nov 10, 1996
Angelia R West Individual W-2 Managing EmployeeRevenue Cycle Management Apr 1, 2013
Joe Fernandez Individual Corporate DirectorBoard Member Jun 15, 2012
Douglas Bridges Individual Corporate DirectorBoard Member Jan 15, 1993
Gary Morris Individual Corporate DirectorBoard Member Nov 13, 2018
Nancy Lord Individual Corporate DirectorBoard Member Jan 21, 2017
Larry Walker Individual Corporate DirectorBoard Member Sep 16, 2013
Cassandra Saffold Individual Corporate DirectorBoard Member Apr 18, 2017
John Barber Individual Corporate OfficerCfo/VP Administrative Services Jul 1, 2015

All facility ownership & control disclosures 11

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Medlink HabershamDemorest, GA, CCN 111975 Federally qualified health center Operational/Managerial Control Jan 13, 2014
Medlink MonroeMonroe, GA, CCN 111037 Federally qualified health center Operational/Managerial Control (100%) Jun 5, 2023
Medlink DanielsvilleDanielsville, GA, CCN 111049 Federally qualified health center Operational/Managerial Control (100%) Jan 14, 2022
Medlink Winder Womens CenterWinder, GA, CCN 111050 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2016
Medlink CommerceCommerce, GA, CCN 111084 Federally qualified health center Operational/Managerial Control (100%) Feb 8, 2018
Medlink JeffersonJefferson, GA, CCN 111141 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2021
Medlink SuchesSuches, GA, CCN 851107 Federally qualified health center Operational/Managerial Control (100%) Oct 20, 2021
Medlink ClevelandCleveland, GA, CCN 851100 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2021
Medlink Georgia IncCleveland, GA, CCN 111898 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2022
Medlink OconeeWatkinsville, GA, CCN 851834 Federally qualified health center Operational/Managerial Control (100%) Apr 22, 2023
Medlink AthensAthens, GA, CCN 851950 Federally qualified health center Operational/Managerial Control (100%) Aug 3, 2023

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20030211000008 GA Part a Provider - Federally Qualified Health Center (FQHC) 3274442850 Practice locations: Winder, GA
O20240827001889 GA DME Supplier - Physician - Podiatry 3274442850 Practice locations: Winder, GA

National Provider Directory

National Provider Directory
Tax ID family
Oglethorpe Family Medic (46 organizations share this tax ID)
Part of
Oglethorpe Family Medic

Locations

133 W Athens St
Winder, GA 30680
Phone (770) 867-6633

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

133 W Athens St
Winder, GA 30680-1786

Mailing address

PO Box 459
Colbert, GA 30628-0459

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
000471765HMedicaidGA

Other names 1

NPPES NPI Registry
  • MEDLINK WINDER Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 3, 2022.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651536000000",
    "number": "1033229059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "COLBERT",
            "state": "GA",
            "postal_code": "306280459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 W ATHENS ST",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306801786",
            "telephone_number": "770-867-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLINK GEORGIA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDLINK GEORGIA INC",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-788-3234"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000471765H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDLINK WINDER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Winder, GA

Sources for this page

Verify at the official NPI Registry.