Provider Demographics
NPI:1346299807
Name:MEDLINK GEORGIA INC
Entity Type:Organization
Organization Name:MEDLINK GEORGIA INC
Other - Org Name:MEDLINK RABUN
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
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:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628-0459
Mailing Address - Country:US
Mailing Address - Phone:706-353-1516
Mailing Address - Fax:706-546-1485
Practice Address - Street 1:896 HIGHWAY 441 S
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-5423
Practice Address - Country:US
Practice Address - Phone:706-782-5991
Practice Address - Fax:706-782-5111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDLINK GEORGIA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC114505AMedicaid
GA000471765RMedicaid
GA000471765RMedicaid