Healthcare Provider Details

I. General information

NPI: 1821481185
Provider Name (Legal Business Name): ATHENS ORTHOPEDIC CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 HIGHWAY 81
LOGANVILLE GA
30052-9112
US

IV. Provider business mailing address

1765 OLD WEST BROAD ST BLDG 2-200
ATHENS GA
30606-2887
US

V. Phone/Fax

Practice location:
  • Phone: 770-554-5009
  • Fax: 706-546-8792
Mailing address:
  • Phone: 706-549-1663
  • Fax: 706-546-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BOBLITZ
Title or Position: CEO
Credential:
Phone: 706-433-3120