NPIMap

Organization Active NPI

Medlink Georgia Inc

  • Federally Qualified Health Center (FQHC)
  • Monroe, GA
National Provider Identifier
1669833364
Registry record updated Feb 11, 2025
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
705 Breedlove Dr Ste 100
Monroe, GA 30655-2080
Phone
(770) 266-0935
NPI assigned
Mar 9, 2016
Last updated
Feb 11, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDLINK GEORGIA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Ward
Title
Ceo
Phone
(706) 788-3234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

705 Breedlove Dr Ste 100
Monroe, GA 30655-2080

Mailing address

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

Other names 1

  • MEDLINK MONROE Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160516000686 GA Part A Provider - Federally Qualified Health Center (FQHC) 3274442850 Practice locations: Monroe, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669833364. Details of each certification follow.

Federally qualified health center certification: CCN 111037

Legal name
MEDLINK GEORGIA INC
Doing business as
MEDLINK MONROE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 16, 2016
Last certification
May 16, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 29, 1980 in GA
Enrollment address
705 Breedlove Dr
Ste 100
Monroe, GA 30655-2080

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
11D2135401Medlink Monroe705 Breedlove Drive, Suite 100, Monroe, GA 30655Provider-performed microscopyAug 21, 2027

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

Locations

704 Breedlove Dr
#B
Monroe, GA 30655
Phone (770) 207-0107

Ownership & related parties

All disclosed owners & managing parties 19

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 Jan 1, 2015
Christopher Gilley Individual Corporate OfficerCfo Jul 21, 2021
Dennis Kimbrell Individual Corporate DirectorDirector of Pharmacy Aug 17, 2017
Bobby Berryman Individual Corporate DirectorMember of Volunteer Community Board Feb 21, 1999
Arthur Gorman Individual Corporate DirectorDirector of Imaging Jan 3, 2022
Marilyn Favors Individual Corporate DirectorMember of Volunteer Community Board Mar 18, 2009
Medlink Georgia Inc Organization, Colbert, GA Corporation, Non-profit Operational/Managerial Control Jun 5, 2023 100%
Merlin Mejia Individual Corporate DirectorVolunteer Board of Directors Oct 15, 2018
Angelia R West Individual W-2 Managing EmployeeDirector of Revenue Cycle MGMT Apr 1, 2013
Alexandra Duvall Individual Corporate DirectorVolunteer Community Board of Direct Sep 21, 2021
Joe Fernandez Individual Corporate DirectorMember of Volunteer Community Board Jun 18, 2012
Douglas Bridges Individual Corporate DirectorMember of Volunteer Community Board Jan 18, 1993
Gary Morris Individual Corporate DirectorVolunteer Board of Directors Oct 20, 2018
Nancy Lord Individual Corporate DirectorVolunteer Board of Directors Jan 19, 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 Board of Directors Apr 21, 2017
John Barber Individual Corporate DirectorVolunteer Community Board of Direct Apr 13, 2023
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 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

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": "1457481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739232000000",
    "number": "1669833364",
    "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",
            "fax_number": "706-788-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 BREEDLOVE DR STE 100",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306552080",
            "telephone_number": "770-266-0935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLINK GEORGIA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDLINK GEORGIA INC",
        "enumeration_date": "2016-03-09",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "DAVID",
        "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 MONROE",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MEDLINK MONROE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Monroe, GA

Sources for this page

Verify at the official NPI Registry.