Medlink Georgia Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Colbert, GA
NPI 1427156264 · NPPES record last updated May 3, 2022
Key facts
- NPI
- 1427156264
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MEDLINK GEORGIA INC
- Practice address
- 11 Charlie Morris Rd
Colbert, GA 30628-2445 - Phone
- (706) 788-2127
- NPI assigned
- Sep 20, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MEDLINK GEORGIA INC
Authorized official
- Name
- David Ward
- Title
- Ceo
- Phone
- (706) 788-3234
Owners & managing parties with NPI records 1
-
Alexandra Hoffman Duvall, PA-C
Corporate family (same tax ID) 45
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Federally qualified health center certification: CCN 111820
- Legal name
- MEDLINK GEORGIA INC
- Doing business as
- MEDLINK COLBERT
- 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
- Corporation · Non-profit
- Incorporated
- Feb 29, 1980 in GA
- Enrollment address
- 11 Charlie Morris Rd
Colbert, GA 30628-2445
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| David Ward |
Corporate Officer |
Jan 1, 2015 | |
| Christopher Gilley |
Corporate Officer |
Jul 21, 2021 | |
| Linda Rame |
Corporate Director | Sep 20, 2022 | |
| Bobby Berryman |
Corporate Director | Jun 1, 2009 | |
| Marilyn Favors |
Corporate Director | Jun 1, 2009 | |
| Merlin Mejia |
Corporate Director |
Sep 17, 2019 | |
| Angelia R West |
W-2 Managing Employee |
Jan 1, 2015 | |
| Alexandra Duvall |
Corporate Director |
Sep 21, 2021 | |
| Joe Fernandez |
Corporate Director | Jun 1, 2009 | |
| Douglas Bridges |
Corporate Director | Jun 1, 2009 | |
| Gary Morris |
Corporate Director |
Oct 14, 2018 | |
| Nancy Lord |
Corporate Director |
Jan 12, 2017 | |
| Cassandra Saffold |
Corporate Director |
Apr 12, 2017 | |
| John Barber |
Corporate Director | Jul 19, 2022 |
All facility ownership & control disclosures 11
| Facility | Type | Role | Since |
|---|---|---|---|
| Medlink Habersham |
Federally qualified health center | Operational/Managerial Control | Jan 13, 2014 |
| Medlink Monroe |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 5, 2023 |
| Medlink Danielsville |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 14, 2022 |
| Medlink Winder Womens Center |
Federally qualified health center | Operational/Managerial Control (100%) | Nov 1, 2016 |
| Medlink Commerce |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 8, 2018 |
| Medlink Jefferson |
Federally qualified health center | Operational/Managerial Control (100%) | Mar 1, 2021 |
| Medlink Suches |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 20, 2021 |
| Medlink Cleveland |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2021 |
| Medlink Georgia Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2022 |
| Medlink Oconee |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 22, 2023 |
| Medlink Athens |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 3, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050506000147 | GA | Part a Provider - Federally Qualified Health Center (FQHC) | 3274442850 | Practice locations: Colbert, GA |
| O20240103003834 | GA | DME Supplier - Physician - Podiatry | 3274442850 | Practice locations: Colbert, GA |
National Provider Directory
- Tax ID family
- Oglethorpe Family Medic
- Part of
- Oglethorpe Family Medic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
11 Charlie Morris Rd
Colbert, GA 30628-2445
Mailing address
PO Box 459
Colbert, GA 30628-0459
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000471765C | Medicaid | GA |
Other names
- MEDLINK COLBERT
Other providers in Colbert, GA
- John S. Kahle
- Elizabeth Broman Long
- Med South EMS Inc
- Medlink Georgia Inc
- Medlink Georgia Inc
- Medlink Georgia Inc
- Bridgett Muckle
- Jorie Muraida
- Cassie Myers
- Isabelle Nicole Orlino
All providers in Colbert, GA · Federally Qualified Health Center (FQHC) in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.