# 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:** 1306563663
- **Authorized official:** SHEVIN D POLLYDORE MD (PHYSICIAN/OWNER)
- **Authorized official phone:** (770) 209-9913

## Contact information

- **Practice address:** 939 BOB ARNOLD BLVD STE A, LITHIA SPRINGS, GA 30122-3258
- **Practice address phone:** (770) 209-9913
- **Practice address fax:** (678) 902-8579
- **Mailing address:** 939 BOB ARNOLD BLVD STE A, LITHIA SPRINGS, GA 30122-3258
- **Mailing address phone:** (770) 209-9913
- **Mailing address fax:** (678) 902-8579

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (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:** 10/26/2022
- **Last updated:** 10/26/2022