Active NPI
Medlink Georgia Inc
- Federally Qualified Health Center (FQHC)
- Winder, GA
National Provider Identifier
1033229059
On this page
- Key facts
- Authorized official
- Corporate family (same tax ID)45
- Medicare participation
- Federally qualified health center certification: CCN 111870
- All disclosed owners & managing parties13
- All facility ownership & control disclosures11
- Medicare enrollment records2
- National Provider Directory
- Specialties & licenses1
- Addresses
- Other identifiers1
- Other names1
- NPI Registry JSON
- Other providers in Winder, GA
- Sources for this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- 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 INC
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.
-
- Federally Qualified Health Center (FQHC)
- Cleveland, GA
- NPI 1023746054
-
- Federally Qualified Health Center (FQHC)
- Commerce, GA
- NPI 1033304274
-
- Federally Qualified Health Center (FQHC)
- Lexington, GA
- NPI 1083724082
-
- Federally Qualified Health Center (FQHC)
- Watkinsville, GA
- NPI 1093401895
-
- Community/Retail Pharmacy
- Demorest, GA
- NPI 1174177638
-
- Federally Qualified Health Center (FQHC)
- Bowman, GA
- NPI 1235249236
-
- Federally Qualified Health Center (FQHC)
- Gainesville, GA
- NPI 1245340264
-
- Community/Retail Pharmacy
- Colbert, GA
- NPI 1245732254
-
- Federally Qualified Health Center (FQHC)
- Hartwell, GA
- NPI 1275643272
-
- Federally Qualified Health Center (FQHC)
- Royston, GA
- NPI 1336259340
-
- Federally Qualified Health Center (FQHC)
- Clayton, GA
- NPI 1346299807
-
- Federally Qualified Health Center (FQHC)
- Colbert, GA
- NPI 1427156264
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
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
- Corporation
- Incorporated
- Feb 29, 1980 in GA
- Enrollment address
- 133 W Athens St
Winder, GA 30680-1786
All disclosed owners & managing parties 13
Medicare enrollment filesAs disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| David Ward | Corporate Officer | Aug 20, 2011 | |
| Fay Burnett | Corporate Director | Jan 21, 2016 | |
| Bobby Berryman | Corporate Director | Feb 1, 1999 | |
| Marilyn Favors | Corporate Director | Mar 15, 2009 | |
| Albert Stone | Corporate Director | Nov 10, 1996 | |
| Angelia R West | W-2 Managing Employee | Apr 1, 2013 | |
| Joe Fernandez | Corporate Director | Jun 15, 2012 | |
| Douglas Bridges | Corporate Director | Jan 15, 1993 | |
| Gary Morris | Corporate Director | Nov 13, 2018 | |
| Nancy Lord | Corporate Director | Jan 21, 2017 | |
| Larry Walker | Corporate Director | Sep 16, 2013 | |
| Cassandra Saffold | Corporate Director | Apr 18, 2017 | |
| John Barber | Corporate Officer | Jul 1, 2015 |
All facility ownership & control disclosures 11
Medicare enrollment filesFacilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Medlink Habersham | Federally qualified health center | Operational/Managerial Control | Jan 13, 2014 |
| Medlink Monroe | Federally qualified health center | Operational/Managerial Control (100%) | Jun 5, 2023 |
| Medlink Danielsville | Federally qualified health center | Operational/Managerial Control (100%) | Jan 14, 2022 |
| Medlink Winder Womens Center | Federally qualified health center | Operational/Managerial Control (100%) | Nov 1, 2016 |
| Medlink Commerce | Federally qualified health center | Operational/Managerial Control (100%) | Feb 8, 2018 |
| Medlink Jefferson | Federally qualified health center | Operational/Managerial Control (100%) | Mar 1, 2021 |
| Medlink Suches | Federally qualified health center | Operational/Managerial Control (100%) | Oct 20, 2021 |
| Medlink Cleveland | Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2021 |
| Medlink Georgia Inc | Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2022 |
| Medlink Oconee | Federally qualified health center | Operational/Managerial Control (100%) | Apr 22, 2023 |
| Medlink Athens | Federally qualified health center | Operational/Managerial Control (100%) | Aug 3, 2023 |
Medicare enrollment records 2
Medicare enrollment files| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Primary |
Addresses
NPPES NPI RegistryPrimary 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| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000471765H | Medicaid | GA |
Other names 1
NPPES NPI Registry- MEDLINK WINDER
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.