NPIMap

Organization Active NPI

Medlink Georgia, Inc

  • Federally Qualified Health Center (FQHC)
  • Suches, GA
National Provider Identifier
1497420764
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MEDLINK GEORGIA, INC
Practice address
56 Firewater LN
Suches, GA 30572-2941
Phone
(706) 788-3234
NPI assigned
Aug 10, 2021
Organization subpart
Yes
Parent organization
MEDLINK GEORGIA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

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 Primary

Addresses

Primary practice location

56 Firewater LN
Suches, GA 30572-2941

Mailing address

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

Other names 1

  • MedLink Suches Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220211000599 GA Part A Provider - Federally Qualified Health Center (FQHC) 3274442850 Practice locations: Suches, GA

Federally qualified health center certification: CCN 851107

Legal name
MEDLINK GEORGIA INC
Doing business as
MEDLINK SUCHES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 12, 2021
Last certification
Nov 12, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 29, 1980 in GA
Enrollment address
56 Firewater LN
Suches, GA 30572-2941

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
11D2235229Medlink Suches56 Firewater Lane, Suches, GA 30572Provider-performed microscopySep 7, 2027

National Provider Directory

National Provider Directory
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.

View all 45

Ownership & related parties

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.

NameRoleSinceShare
David Ward Individual Corporate OfficerCeo May 16, 2018
Christopher Gilley Individual Corporate OfficerCfo Jul 21, 2021
Dennis Kimbrell Individual Corporate DirectorDirector of Pharmacy Aug 17, 2017
Fay Burnett Individual Corporate DirectorVolunteer Community Board of Direct Jan 16, 2016
Bobby Berryman Individual Corporate DirectorVolunteer Community Board of Direct Feb 17, 1999
Arthur Gorman Individual Corporate DirectorDirector of Imaging Jan 3, 2022
Marilyn Favors Individual Corporate DirectorVolunteer Community Board of Direct Mar 14, 2009
Albert Stone Individual Corporate DirectorVolunteer Community Board of Direct Nov 14, 1996
Medlink Georgia Inc Organization, Colbert, GA Non-profit Operational/Managerial Control Oct 20, 2021 100%
Merlin Mejia Individual Corporate DirectorVolunteer Community Board of Direct Sep 17, 2019
Angelia R West Individual W-2 Managing EmployeeDirector of Revenue Cycle MGMT May 16, 2018
Alexandra Duvall Individual Corporate DirectorVolunteer Community BRD of Director Sep 21, 2021
Joe Fernandez Individual Corporate DirectorVolunteer Community Board of Direct Jun 15, 2012
Douglas Bridges Individual Corporate DirectorVolunteer Community Board of Direct Jan 31, 1993
Gary Morris Individual Corporate DirectorVolunteer Community Board of Direct Oct 14, 2018
Nancy Lord Individual Corporate DirectorVolunteer Community Board of Direct Jan 12, 2017
Mushtaq Ahmed Individual Corporate OfficerChief Medical Officer Sep 1, 2016
Trisha Jones Individual Corporate OfficerChief Nursing Officer May 7, 2024
Cassandra Saffold Individual Corporate DirectorVolunteer Community Board of Direct Apr 12, 2017
John Barber Individual Corporate DirectorVolunteer Board of Director Jul 21, 2022
Sherrie Stone Individual Corporate DirectorDirector of Operations Mar 15, 2015

Owners & managing parties with NPI records 2

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 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

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": "1628553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1497420764",
    "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": "56 FIREWATER LN",
            "city": "SUCHES",
            "state": "GA",
            "postal_code": "305722941",
            "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": "2021-08-10",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "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 Suches",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suches, GA

Sources for this page

Verify at the official NPI Registry.