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
3200 SHAKERAG HL STE A, PEACHTREE CITY, GA 30269-6524
(770) 769-1724
(770) 708-6599
Mailing address
939 BOB ARNOLD BLVD STE A, LITHIA SPRINGS, GA 30122-3258
(770) 769-1724
(770) 708-6599
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
333600000X
Pharmacy
—
—
Other
Enumeration date
04/20/2023
Last updated
11/22/2023
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