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Medlink Georgia, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Cleveland, GA

NPI 1043987910 · NPPES record last updated Aug 27, 2021

Key facts

NPI
1043987910
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
MEDLINK GEORGIA, INC
Practice address
25 Old Blairsville Rd
Cleveland, GA 30528-1129
Phone
(706) 969-7510
NPI assigned
Aug 27, 2021
Organization subpart
Yes
Parent organization (as reported)
MEDLINK GEORGIA, INC

Authorized official

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

Owners & managing parties with NPI records 1

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

Corporate family (same tax ID) 45

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

View all 45

Facilities with the same owner 10

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

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
Corporation · Non-profit
Incorporated
Feb 29, 1980 in GA
Enrollment address
25 Old Blairsville Rd
Cleveland, GA 30528-1129

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 Officer
Ceo		 Jan 15, 2015
Christopher Gilley
Individual 		Corporate Officer
Cfo		 Jul 21, 2021
Bobby Berryman
Individual 		Corporate Director
Volunteer Community Board of Direct		 Feb 17, 1999
Marilyn Favors
Individual 		Corporate Director
Volunteer Community Board of Direct		 Mar 14, 2009
Albert Stone
Individual 		Corporate Director
Volunteer 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 Director
Volunteer Community Board of Direct		 Sep 17, 2019
Angelia R West
Individual 		W-2 Managing Employee
Director of Rev Cycle Management		 Apr 1, 2013
Alexandra Duvall
Individual 		Corporate Director
Volunteer Community Board of Direct		 Sep 21, 2021
Joe Fernandez
Individual 		Corporate Director
Volunteer Community Board of Direct		 Jun 15, 2012
Douglas Bridges
Individual 		Corporate Director
Volunteer Community Board of Direct		 Jan 12, 1993
Gary Morris
Individual 		Corporate Director
Volunteer Community Board of Direct		 Oct 14, 2018
Nancy Lord
Individual 		Corporate Director
Volunteer Community Board of Direct		 Jan 12, 2017
Cassandra Saffold
Individual 		Corporate Director
Volunteer Community Board of Direct		 Apr 12, 2017

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 Habersham
Demorest, GA · CCN 111975		 Federally qualified health center Operational/Managerial Control Jan 13, 2014
Medlink Monroe
Monroe, GA · CCN 111037		 Federally qualified health center Operational/Managerial Control (100%) Jun 5, 2023
Medlink Danielsville
Danielsville, GA · CCN 111049		 Federally qualified health center Operational/Managerial Control (100%) Jan 14, 2022
Medlink Winder Womens Center
Winder, GA · CCN 111050		 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2016
Medlink Commerce
Commerce, GA · CCN 111084		 Federally qualified health center Operational/Managerial Control (100%) Feb 8, 2018
Medlink Jefferson
Jefferson, GA · CCN 111141		 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2021
Medlink Suches
Suches, GA · CCN 851107		 Federally qualified health center Operational/Managerial Control (100%) Oct 20, 2021
Medlink Georgia Inc
Cleveland, GA · CCN 111898		 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2022
Medlink Oconee
Watkinsville, GA · CCN 851834		 Federally qualified health center Operational/Managerial Control (100%) Apr 22, 2023
Medlink Athens
Athens, GA · CCN 851950		 Federally qualified health center Operational/Managerial Control (100%) Aug 3, 2023

Medicare enrollment records

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

National Provider Directory

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

Interoperability endpoints

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

Specialties & licenses

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

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

  • MedLink Cleveland Doing business as

Other providers in Cleveland, GA

All providers in Cleveland, GA · Federally Qualified Health Center (FQHC) in Georgia

Sources for this page

Verify at the official NPI Registry.