Medlink Georgia Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MEDLINK GEORGIA INC

Practice address

112 Banks Rd
Ste 1
Commerce, GA 30529-6300

Phone

(706) 677-4568

NPI assigned

Sep 11, 2007

Last updated

Nov 20, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

MEDLINK GEORGIA INCAs reported in NPPES

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

Authorized official

Name

David Ward

Title

Ceo

Phone

(706) 788-3234

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033304274. Details of each certification follow.

• CCN 111906 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 111906

Legal name

MEDLINK GEORGIA INC

Doing business as

MEDLINK BANKS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 19, 2008

Last certification

Feb 19, 2008

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Feb 20, 1980 in GA

Enrollment address

112 Banks Rd
Ste 1
Commerce, GA 30529

Tax ID family

Medlink Georgia Inc46 organizations share this tax ID, including this one

Part of

Medlink Georgia Inc

Other organizations with this tax ID 45

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

• Medlink Georgia Inc

  dba MedLink White School Based Health Center

  • Federally Qualified Health Center (FQHC)
  • Cleveland, GA
  • NPI 1023746054
  NPD tax ID
• Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Winder, GA
  • NPI 1033229059
  NPD tax ID
• Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Lexington, GA
  • NPI 1083724082
  NPD tax ID
• Medlink Georgia Inc

  dba MedLink Oconee

  • Federally Qualified Health Center (FQHC)
  • Watkinsville, GA
  • NPI 1093401895
  NPD tax ID
• Medlink Georgia Inc

  dba MedLink Pharmacy - Habersham

  • Community/Retail Pharmacy
  • Demorest, GA
  • NPI 1174177638
  NPD tax ID
• Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Bowman, GA
  • NPI 1235249236
  NPD tax ID
• Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Gainesville, GA
  • NPI 1245340264
  NPD tax ID
• Medlink Georgia Inc

  dba Medlink Pharmacy- Colbert

  • Community/Retail Pharmacy
  • Colbert, GA
  • NPI 1245732254
  NPD tax ID
• Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Hartwell, GA
  • NPI 1275643272
  NPD tax ID
• Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Royston, GA
  • NPI 1336259340
  NPD tax ID
• Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Clayton, GA
  • NPI 1346299807
  NPD tax ID
• Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Colbert, GA
  • NPI 1427156264
  NPD tax ID

Locations

All disclosed owners & managing parties 17

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

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Mushtaq Ahmed, M.D.

  • Family Medicine Physician
  • Winder, GA
  • NPI 1457592552

  Corporate Officer

  CMS ownership
• Alexandra Hoffman Duvall, PA-C

  • Physician Assistant
  • Hiawassee, GA
  • NPI 1629318191

  Corporate Director

  CMS ownership

All facility ownership & control disclosures 11

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

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1033304274",
    "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",
            "telephone_number": "706-788-3234",
            "fax_number": "706-788-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 BANKS RD",
            "address_2": "STE 1",
            "city": "COMMERCE",
            "state": "GA",
            "postal_code": "305296300",
            "telephone_number": "706-677-4568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLINK GEORGIA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDLINK GEORGIA INC",
        "enumeration_date": "2007-09-11",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-15",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000471765S",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert P Marshburn, MD
• Thomas Clayton Martin Jr., PHARMD
• Robert F McWhorter, PHARM.D.
• Meadows Surgical Arts
• Medical Center Family Practice
• Medlink Georgia, Inc (MedLink Commerce)
• Medlink Georgia, Inc
• Medlink Georgia, Inc (MedLink Commerce Family Foot Clinic)
• Medlink Georgia, Inc (MedLink Pharmacy - Banks)
• Zachary Miller

• Federally Qualified Health Center (FQHC) in Commerce, GA
• Providers in Commerce, GA by specialty
• Federally Qualified Health Center (FQHC) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; 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.

Verify at the official NPI Registry.