Medlink Georgia Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MEDLINK GEORGIA INC

Practice address

247 Union Point St
Lexington, GA 30648-2303

Phone

(706) 743-8171

NPI assigned

Aug 30, 2006

Last updated

May 3, 2022By 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

Other names 1

• MEDLINK OGLETHORPE Other name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083724082. Details of each certification follow.

• CCN 111821 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 111821

Legal name

MEDLINK GEORGIA INC

Doing business as

MEDLINK OGLETHORPE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 1, 1991

Last certification

Oct 1, 1991

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Feb 29, 1980 in GA

Enrollment address

247 Union Point St
Lexington, GA 30648-2303

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)
  • Commerce, GA
  • NPI 1033304274
  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

All disclosed owners & managing parties 21

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

  W-2 Managing Employee

  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": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651536000000",
    "number": "1083724082",
    "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": "247 UNION POINT ST",
            "city": "LEXINGTON",
            "state": "GA",
            "postal_code": "306482303",
            "telephone_number": "706-743-8171"
        }
    ],
    "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000471765A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDLINK OGLETHORPE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Linda M Hueseman, M.D.
• Michael Kempf, DDS
• Lexington Primary Care LLC
• Lexinton Pharmacies Inc. (Skrip Shoppe Pharmacy)
• Caylie Lane Mahaffey, DNP
• Medlink Georgia, Inc (MedLink Patriot School Based Health Center)
• Zachary H Newman, MD
• Oglethorpe County Board of Education
• Oglethorpe County Health Department (Oglethorpe Co BD of HLTH)
• Oglethorpe County Health Department

• Federally Qualified Health Center (FQHC) in Lexington, GA
• Providers in Lexington, 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 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.

Verify at the official NPI Registry.