Medlink Georgia, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MEDLINK GEORGIA, INC

Practice address

125 W Athens St
Winder, GA 30680-1710

Phone

(706) 867-6633

NPI assigned

Oct 22, 2021

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

Dave Ward

Title

Ceo

Phone

(706) 788-3234

Specialties & licenses 1

Addresses

Other names 1

• MedLink Winder Ancillary Other name

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

Federally qualified health center certification: CCN 851124

Legal name

MEDLINK GEORGIA INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 13, 2022

Last certification

Jan 13, 2022

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Feb 29, 1980 in GA

Enrollment address

125 W Athens St
Winder, GA 30680-1710

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Lawrenceville, GA
  • NPI 1649829532

  O20240812003379

  Same enrollment

Tax ID family

Oglethorpe Family Medic46 organizations share this tax ID, including this one

Part of

Oglethorpe Family Medic

Other organizations with this tax ID 45

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

• Medlink Georgia Inc

  • 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

  • Federally Qualified Health Center (FQHC)
  • Lexington, GA
  • NPI 1083724082
  NPD tax ID
• Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Watkinsville, GA
  • NPI 1093401895
  NPD tax ID
• Medlink Georgia Inc

  • 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

  • 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

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.

Owners & managing parties with NPI records 1

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

• 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.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ann Whitaker, RD/N, LD, CDE

  • Registered Dietitian
  • Duluth, GA
  • NPI 1699158584
  NPD
• Jennifer Ruth Wright, MS RD/LDN

  • Registered Dietitian
  • Colbert, GA
  • NPI 1528615713
  NPD

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

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634860800000",
    "number": "1497419808",
    "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": "125 W ATHENS ST",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306801710",
            "telephone_number": "706-867-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLINK GEORGIA, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDLINK GEORGIA, INC",
        "enumeration_date": "2021-10-22",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-06",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedLink Winder Ancillary",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Robin Medina, OTR/L
• Medlink Georgia Inc
• Medlink Georgia Inc
• Medlink Georgia Inc
• Medlink Georgia, Inc
• Medlink Georgia, Inc
• Betsy O Mejias, LCSW, BCCC
• MH Health Care Services, PC
• Michael L Serrano OD
• Miller Family Chiropractic

• Federally Qualified Health Center (FQHC) in Winder, GA
• Providers in Winder, 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 Oct 22, 2021; 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.