NPIMap

Organization Active NPI

Orthoxpress of Georgia

  • Physician Assistant
  • Acworth, GA
National Provider Identifier
1093481251
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
ORTHOXPRESS OF GEORGIA
Practice address
4900 Ivey Rd NW Ste 1401
Acworth, GA 30101-4007
Phone
(470) 648-8108
Fax
(470) 648-8109
NPI assigned
Aug 18, 2021
Last updated
Jul 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Authorized official

Name
Jennifer C Bullock
Title
President
Phone
(662) 534-2227

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

4900 Ivey Rd NW Ste 1401
Acworth, GA 30101-4007

Mailing address

206 Oxford Rd
New Albany, MS 38652-3115
Phone (662) 534-2227

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jacob.wallis.1@11099.direct.athenahealth.com Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20250305000516 GA Part B Supplier - Clinic/Group Practice 0042731291 Receives reassigned benefits from 4 practitioners
Practice locations: Roswell, GA; Marietta, GA; Acworth, GA; Fayetteville, GA
O20250529000578 GA DME Supplier - Physician Assistant 0042731291 Practice locations: Acworth, GA

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Locations

4900 Ivey Rd NW
Ste 1401
Acworth, GA 30101
Phone (470) 648-8108

104 N Park Dr
Fayetteville, GA 30214
Phone (470) 944-5290

2550 Sandy Plains Rd
Ste 125
Marietta, GA 30066
Phone (770) 824-9421

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783900800000",
    "number": "1093481251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 OXFORD RD",
            "city": "NEW ALBANY",
            "state": "MS",
            "postal_code": "386523115",
            "telephone_number": "662-534-2227",
            "fax_number": "662-534-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 IVEY RD NW STE 1401",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301014007",
            "telephone_number": "470-648-8108",
            "fax_number": "470-648-8109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOXPRESS OF GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-534-2227"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacob.wallis.1@11099.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Athena Health",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "104 N Park Dr",
            "city": "Fayetteville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302141645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Acworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.