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Organization
REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE, INC
Active
Organization
REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE, INC
Active
Other names
Revive Orthopedics Spine & Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
SHEVIN POLLYDORE MD (OWNER)
(770) 769-1724
Entity
Organization
Contact information
Practice address
1750 OLD SPRING HOUSE LN STE 205, DUNWOODY, GA 30338-6214
(770) 769-1724
(770) 708-6599
Mailing address
939 BOB ARNOLD BLVD STE A, LITHIA SPRINGS, GA 30122-3258
(770) 769-1724
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/16/2024
Last updated
07/16/2024
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