# REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revive Orthopedics Spine & Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134967995
- **Authorized official:** SHEVIN POLLYDORE MD (OWNER)
- **Authorized official phone:** (770) 769-1724

## Contact information

- **Practice address:** 1750 OLD SPRING HOUSE LN STE 205, DUNWOODY, GA 30338-6214
- **Practice address phone:** (770) 769-1724
- **Practice address fax:** (770) 708-6599
- **Mailing address:** 939 BOB ARNOLD BLVD STE A, LITHIA SPRINGS, GA 30122-3258
- **Mailing address phone:** (770) 769-1724

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |

## Other

- **Enumeration date:** 07/16/2024
- **Last updated:** 07/16/2024