Medlink Georgia Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MEDLINK GEORGIA INC

Doing business as

MedLink Gwinnett

Practice address

980 Lawrenceville Hwy
Lawrenceville, GA 30046-4706

Phone

(770) 676-6500

NPI assigned

Sep 4, 2019

Last updated

Feb 11, 2025By the provider in NPPES

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 2

• MedLink Gwinnett Doing business as
• MedLink Lawrenceville Other name

Medicare fee-for-service enrollment

Enrolled in GA3 enrollments

Enrollment records 3

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649829532. Details of each certification follow.

• CCN 111116 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 111116

Legal name

MEDLINK GEORGIA INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Nov 11, 2019

Last certification

Nov 11, 2019

Ownership / control type

For profit – partnership

Organization structure

CorporationNon-profit

Incorporated

Feb 29, 1980 in GA

Enrollment address

980 Lawrenceville Hwy
Lawrenceville, GA 30046-4706

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)
  • Winder, GA
  • NPI 1497419808

  O20240812003379

  Same enrollment

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

CLIA laboratory certificates

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.

• Medlink Georgia Inc

  dba MedLink White School Based Health Center

  • 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

  dba MedLink Oconee

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

  dba MedLink Pharmacy - Habersham

  • 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

  dba Medlink Pharmacy- Colbert

  • 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

Locations

All disclosed owners & managing parties 18

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 2

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

• Mushtaq Ahmed, M.D.

  • Family Medicine Physician
  • Winder, GA
  • NPI 1457592552

  Corporate Officer

  CMS ownership
• 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 3

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.

• Paloma Vega, MS, RD, LD

  • Registered Dietitian
  • Commerce, GA
  • NPI 1528942711
  NPD
• 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": "1567555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739232000000",
    "number": "1649829532",
    "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": "980 LAWRENCEVILLE HWY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464706",
            "telephone_number": "770-676-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLINK GEORGIA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDLINK GEORGIA INC",
        "enumeration_date": "2019-09-04",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "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 Gwinnett",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedLink Gwinnett",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedLink Lawrenceville",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Federally Qualified Health Center (FQHC) in Lawrenceville, GA
• Providers in Lawrenceville, 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 Feb 11, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.