NPIMap

Organization Active NPI

Medlink Georgia, Inc

  • Radiology Clinic/Center
  • Commerce, GA
National Provider Identifier
1487337176
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
MEDLINK GEORGIA, INC
Practice address
112 Banks Rd.
Ste. 2
Commerce, GA 30529-6300
Phone
(706) 788-3234
NPI assigned
Aug 9, 2023
Last updated
Nov 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDLINK GEORGIA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 20, 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
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

112 Banks Rd.
Ste. 2
Commerce, GA 30529-6300

Mailing address

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

Other names 1

  • MedLink Banks Imaging Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240104000893 GA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3274442850 Practice locations: Commerce, GA

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

Ownership & related parties

All facility ownership & control disclosures 11

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 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

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1487337176",
    "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": "112 BANKS RD.",
            "address_2": "STE. 2",
            "city": "COMMERCE",
            "state": "GA",
            "postal_code": "305296300",
            "telephone_number": "706-788-3234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLINK GEORGIA, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDLINK GEORGIA, INC",
        "enumeration_date": "2023-08-09",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-15",
        "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": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedLink Banks Imaging",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MedLink Banks Imaging",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Commerce, GA

Sources for this page

Verify at the official NPI Registry.