Organization
REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE, INC
Active
Parent organization
REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE, INC
Other names
Revive Orthopedics Spine & Sports Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE, INC
Authorized official
SHEVIN D POLLYDORE MD (PHYSICIAN/OWNER)
(770) 209-9913
Entity
Organization
Contact information
Practice address
3955 HARRISON RD STE 200B, LOGANVILLE, GA 30052-8502
(770) 209-9913
(678) 902-8579
Mailing address
3955 HARRISON RD STE 200B, LOGANVILLE, GA 30052-8502
(770) 209-9913
(678) 902-8579
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
333600000X
Pharmacy
—
—
Other
Enumeration date
12/01/2022
Last updated
12/01/2022
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