NPIMap

Organization Active NPI

Medlink Georgia Inc

Doing business as MedLink Oconee

  • Federally Qualified Health Center (FQHC)
  • Watkinsville, GA
National Provider Identifier
1093401895
Registry record updated Apr 13, 2023
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 Oconee
Practice address
1160 Capital Ave Ste 105
Watkinsville, GA 30677-1832
Phone
(706) 521-3113
NPI assigned
Apr 13, 2023
Last updated
Apr 13, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDLINK GEORGIA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

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 NU Primary

Addresses

Primary practice location

1160 Capital Ave Ste 105
Watkinsville, GA 30677-1832

Mailing address

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

Other names 1

  • MedLink Oconee Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230512000221 GA Part A Provider - Federally Qualified Health Center (FQHC) 3274442850 Practice locations: Watkinsville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093401895. Details of each certification follow.

Federally qualified health center certification: CCN 851834

Legal name
MEDLINK GEORGIA INC
Doing business as
MEDLINK OCONEE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 12, 2023
Last certification
May 12, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 29, 1980 in GA
Enrollment address
1160 Capital Ave
Ste 105
Watkinsville, GA 30677-1832

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2283250Medlink Oconee1160 Capital Avenue, Watkinsville, GA 30677Provider-performed microscopyJun 4, 2027

National Provider Directory

National Provider Directory
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.

View all 45

Ownership & related parties

All disclosed owners & managing parties 15

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 OfficerPresident and Ceo Jan 1, 2015
Christopher Gilley Individual Corporate OfficerCfo Jul 21, 2021
Linda Rame Individual Corporate Director Sep 20, 2022
Bobby Berryman Individual Corporate Director Feb 22, 1999
Marilyn Favors Individual Corporate Director Mar 19, 2009
Medlink Georgia Inc Organization, Colbert, GA Non-profit Operational/Managerial Control Apr 22, 2023 100%
Merlin Mejia Individual Corporate Director Sep 17, 2019
Angelia R West Individual W-2 Managing EmployeeDirector of Revenue Cycle MGMT Apr 1, 2013
Alexandra Duvall Individual Corporate Director Sep 21, 2021
Joe Fernandez Individual Corporate Director Jun 17, 2012
Douglas Bridges Individual Corporate Director Jan 21, 1993
Gary Morris Individual Corporate Director Oct 14, 2018
Nancy Lord Individual Corporate Director Jan 21, 2017
Cassandra Saffold Individual Corporate Director Apr 18, 2017
John Barber Individual Corporate Director Jul 19, 2022

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 ClevelandCleveland, GA, CCN 851100 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2021
Medlink Georgia IncCleveland, GA, CCN 111898 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2022
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": "1681344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681344000000",
    "number": "1093401895",
    "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": "1160 CAPITAL AVE STE 105",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306771832",
            "telephone_number": "706-521-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLINK GEORGIA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDLINK GEORGIA, INC",
        "enumeration_date": "2023-04-13",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedLink Oconee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watkinsville, GA

Sources for this page

Verify at the official NPI Registry.