Healthcare Provider Details

I. General information

NPI: 1306563515
Provider Name (Legal Business Name): MEDLINK GEORGIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 MOUNTAIN CITY RD
CLAYTON GA
30525-3072
US

IV. Provider business mailing address

PO BOX 459
COLBERT GA
30628-0459
US

V. Phone/Fax

Practice location:
  • Phone: 706-521-3113
  • Fax:
Mailing address:
  • Phone: 706-788-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DAVE WARD
Title or Position: CEO
Credential:
Phone: 706-788-3234