NPIMap

Organization Active NPI

Athens Orthopedic Clinic, PA

  • Orthopaedic Surgery Physician
  • Athens, GA
National Provider Identifier
1063495299
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ATHENS ORTHOPEDIC CLINIC, PA
Practice address
1765 Old West Broad St
Athens, GA 30606-2853
Phone
(706) 549-1663
Fax
(706) 546-8792
NPI assigned
Nov 22, 2005
Last updated
Sep 3, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ATHENS ORTHOPEDIC CLINIC, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Boblitz
Title
Ceo
Phone
(706) 549-1663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

1765 Old West Broad St
Athens, GA 30606-2853

Mailing address

1765 Old West Broad St BLDG 2-200
Athens, GA 30606-2887
Phone (706) 549-1663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031201000709 GA Part B Supplier - Clinic/Group Practice 5991600181 Receives reassigned benefits from 73 practitioners
Practice locations: Monroe, GA; Elberton, GA; Greensboro, GA; Lavonia, GA; Loganville, GA; Madison, GA; Royston, GA; Snellville, GA…
O20100930006526 GA DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Prosthetic Personnel 5991600181 Practice locations: Athens, GA

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1054478Athens Orthopedic Clinic ASC1765 Old West Broad St, BLDG 1, Suite 300, Athens, GA 30606Certificate of waiverMay 22, 2028

National Provider Directory

National Provider Directory

Locations

1765 Old West Broad St
Ste 200
Athens, GA 30606
Phone (706) 433-4088

1774 Old West Broad St
Athens, GA 30606
Phone (706) 548-6476

5303 Adams St NE
Ste A
Covington, GA 30014
Phone (770) 554-5009

Practitioners & affiliated clinicians

Practitioners 81

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 81

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788393600000",
    "number": "1063495299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 OLD WEST BROAD ST BLDG 2-200",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062887",
            "telephone_number": "706-549-1663",
            "fax_number": "706-286-7426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 OLD WEST BROAD ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062853",
            "telephone_number": "706-549-1663",
            "fax_number": "706-546-8792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENS ORTHOPEDIC CLINIC, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATHENS ORTHOPEDIC CLINIC, PA",
        "enumeration_date": "2005-11-22",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A",
        "authorized_official_last_name": "BOBLITZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-549-1663"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.