Medlink Georgia Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Monroe, GA
NPI 1669833364 · NPPES record last updated Feb 11, 2025
Key facts
- NPI
- 1669833364
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- Yes
- Parent organization (as reported)
- MEDLINK GEORGIA INC
Authorized official
- Name
- David Ward
- Title
- Ceo
- Phone
- (706) 788-3234
Owners & managing parties with NPI records 2
-
Mushtaq Ahmed, M.D.
-
Alexandra Hoffman Duvall, PA-C
Corporate family (same tax ID) 45
Facilities with the same owner 10
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2135401 | Medlink Monroe | Provider-performed microscopy | Aug 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
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
- Corporation · Non-profit
- Incorporated
- Feb 29, 1980 in GA
- Enrollment address
- 705 Breedlove Dr
Ste 100
Monroe, GA 30655-2080
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| David Ward |
Corporate Officer |
Jan 1, 2015 | |
| Christopher Gilley |
Corporate Officer |
Jul 21, 2021 | |
| Dennis Kimbrell |
Corporate Director |
Aug 17, 2017 | |
| Bobby Berryman |
Corporate Director |
Feb 21, 1999 | |
| Arthur Gorman |
Corporate Director |
Jan 3, 2022 | |
| Marilyn Favors |
Corporate Director |
Mar 18, 2009 | |
| Medlink Georgia Inc |
Operational/Managerial Control | Jun 5, 2023 | 100% |
| Merlin Mejia |
Corporate Director |
Oct 15, 2018 | |
| Angelia R West |
W-2 Managing Employee |
Apr 1, 2013 | |
| Alexandra Duvall |
Corporate Director |
Sep 21, 2021 | |
| Joe Fernandez |
Corporate Director |
Jun 18, 2012 | |
| Douglas Bridges |
Corporate Director |
Jan 18, 1993 | |
| Gary Morris |
Corporate Director |
Oct 20, 2018 | |
| Nancy Lord |
Corporate Director |
Jan 19, 2017 | |
| Mushtaq Ahmed |
Corporate Officer |
Sep 1, 2016 | |
| Trisha Jones |
Corporate Officer |
May 7, 2024 | |
| Cassandra Saffold |
Corporate Director |
Apr 21, 2017 | |
| John Barber |
Corporate Director |
Apr 13, 2023 | |
| Sherrie Stone |
Corporate Director |
Mar 15, 2015 |
All facility ownership & control disclosures 10
| Facility | Type | Role | Since |
|---|---|---|---|
| Medlink Habersham |
Federally qualified health center | Operational/Managerial Control | Jan 13, 2014 |
| Medlink Danielsville |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 14, 2022 |
| Medlink Winder Womens Center |
Federally qualified health center | Operational/Managerial Control (100%) | Nov 1, 2016 |
| Medlink Commerce |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 8, 2018 |
| Medlink Jefferson |
Federally qualified health center | Operational/Managerial Control (100%) | Mar 1, 2021 |
| Medlink Suches |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 20, 2021 |
| Medlink Cleveland |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2021 |
| Medlink Georgia Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2022 |
| Medlink Oconee |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 22, 2023 |
| Medlink Athens |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 3, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160516000686 | GA | Part a Provider - Federally Qualified Health Center (FQHC) | 3274442850 | Practice locations: Monroe, GA |
National Provider Directory
- Tax ID family
- Oglethorpe Family Medic
- Part of
- Oglethorpe Family Medic
Locations
704 Breedlove Dr
#B
Monroe, GA 30655
Phone (770) 207-0107
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
- MEDLINK MONROE
Other providers in Monroe, GA
- Michael David McMunn
- Prechus McNeal
- Lauren McNeely
- Corey Williman McTeer
- MD Pain Care, P.C.
- Angela Dawn Meeks
- James Townsend Merwin IV
- MH Health Care Services, PC
- Michael D Hughes, DC, PC
- Douglas Christian Miller
All providers in Monroe, GA · Federally Qualified Health Center (FQHC) in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.