NPIMap

Organization Active NPI

Medlink Georgia, Inc

Doing business as MedLink Cleveland

  • Federally Qualified Health Center (FQHC)
  • Cleveland, GA
National Provider Identifier
1043987910
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MEDLINK GEORGIA, INC
Doing business as
MedLink Cleveland
Practice address
25 Old Blairsville Rd
Cleveland, GA 30528-1129
Phone
(706) 969-7510
NPI assigned
Aug 27, 2021
Last updated
Aug 27, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDLINK GEORGIA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Authorized official

Name
Dave Ward
Title
Ceo
Phone
(706) 788-3234

Specialties & licenses 1

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

Addresses

Primary practice location

25 Old Blairsville Rd
Cleveland, GA 30528-1129

Mailing address

PO Box 459
Colbert, GA 30628-0459
Phone (706) 788-3234

Other names 1

  • MedLink Cleveland Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220211000943 GA Part A Provider - Federally Qualified Health Center (FQHC) 3274442850 Practice locations: Cleveland, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043987910. Details of each certification follow.

Federally qualified health center certification: CCN 851100

Legal name
MEDLINK GEORGIA INC
Doing business as
MEDLINK CLEVELAND
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 29, 2021
Last certification
Dec 29, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 29, 1980 in GA
Enrollment address
25 Old Blairsville Rd
Cleveland, GA 30528-1129

National Provider Directory

National Provider Directory
Tax ID family
NE Ga Family Med Ctr in47 organizations share this tax ID, including this one
Part of
NE Ga Family Med Ctr in

Other organizations with this tax ID 46

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

View all 46

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9864/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 14

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 Jan 15, 2015
Christopher Gilley Individual Corporate OfficerCfo Jul 21, 2021
Bobby Berryman Individual Corporate DirectorVolunteer Community Board of Direct Feb 17, 1999
Marilyn Favors Individual Corporate DirectorVolunteer Community Board of Direct Mar 14, 2009
Albert Stone Individual Corporate DirectorVolunteer Community Board of Direct Nov 14, 1996
Medlink Georgia Inc Organization, Colbert, GA Non-profit Operational/Managerial Control Oct 1, 2021 100%
Merlin Mejia Individual Corporate DirectorVolunteer Community Board of Direct Sep 17, 2019
Angelia R West Individual W-2 Managing EmployeeDirector of Rev Cycle Management Apr 1, 2013
Alexandra Duvall Individual Corporate DirectorVolunteer Community Board of Direct Sep 21, 2021
Joe Fernandez Individual Corporate DirectorVolunteer Community Board of Direct Jun 15, 2012
Douglas Bridges Individual Corporate DirectorVolunteer Community Board of Direct Jan 12, 1993
Gary Morris Individual Corporate DirectorVolunteer Community Board of Direct Oct 14, 2018
Nancy Lord Individual Corporate DirectorVolunteer Community Board of Direct Jan 12, 2017
Cassandra Saffold Individual Corporate DirectorVolunteer Community Board of Direct Apr 12, 2017

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 10

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 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

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1043987910",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 OLD BLAIRSVILLE RD",
            "city": "CLEVELAND",
            "state": "GA",
            "postal_code": "305281129",
            "telephone_number": "706-969-7510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLINK GEORGIA, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDLINK GEORGIA, INC",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "DAVE",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedLink Cleveland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, GA

Sources for this page

Verify at the official NPI Registry.