Provider Demographics
NPI:1073243408
Name:MEDLINK GEORGIA, INC
Entity Type:Organization
Organization Name:MEDLINK GEORGIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-788-3234
Mailing Address - Street 1:206 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:GA
Mailing Address - Zip Code:30624-2109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:GA
Practice Address - Zip Code:30624-2109
Practice Address - Country:US
Practice Address - Phone:706-338-5075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDLINK GEORGIA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy