Healthcare Provider Details

I. General information

NPI: 1396794541
Provider Name (Legal Business Name): MEDLINK GEORGIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CHARLIE MORRIS RD
COLBERT GA
30628-2445
US

IV. Provider business mailing address

PO BOX 459
COLBERT GA
30628-0459
US

V. Phone/Fax

Practice location:
  • Phone: 706-788-3234
  • Fax:
Mailing address:
  • Phone: 706-788-3234
  • Fax: 706-788-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

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