Provider Demographics
NPI:1972480234
Name:MEDICALLY LINKED, LLC
Entity type:Organization
Organization Name:MEDICALLY LINKED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-604-0298
Mailing Address - Street 1:1100 REVOLUTION MILL DR STE A1
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5067
Mailing Address - Country:US
Mailing Address - Phone:470-604-0298
Mailing Address - Fax:
Practice Address - Street 1:1100 REVOLUTION MILL DR STE A1
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5067
Practice Address - Country:US
Practice Address - Phone:470-604-0298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory