MEDICARE: ATHENS ORTHOPEDIC CLINIC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1245623560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHENS ORTHOPEDIC CLINIC, PA

Provider Business Mailing Address
First Line	:	1765 OLD WEST BROAD ST
Second Line	:	BLDG 2, STE 200
City	:	ATHENS
State	:	GA
Zip	:	30606-2853
Country	:	US
Telephone Number	:	706-549-1663
Fax Number	:	706-546-8792

Provider Business Practice Location Address
First Line	:	5303 ADAMS ST NE
Second Line	:	STE A
City	:	COVINGTON
State	:	GA
Zip	:	30014-6208
Country	:	US
Telephone Number	:	706-549-1663
Fax Number	:	706-546-8792

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL BOBLITZ
Credential	:
Telephone Number	:	706-433-3120

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	05/08/2025

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