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 D POLLYDORE MD (PHYSICIAN/OWNER)
(770) 209-9913
Entity
Organization
Contact information
Practice address
939 BOB ARNOLD BLVD STE A, LITHIA SPRINGS, GA 30122-3258
(770) 209-9913
(678) 902-8579
Mailing address
939 BOB ARNOLD BLVD STE A, LITHIA SPRINGS, GA 30122-3258
(770) 209-9913
(678) 902-8579
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
10/26/2022
Last updated
10/26/2022
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