Revive Orthopedics Spine & Sports Medicine, INC
NPI #1841900636 in Loganville, Georgia
Provider Information
- NPI Number
- 1841900636
- Entity Type
- Organization
- Organization Name
- Revive Orthopedics Spine & Sports Medicine, INC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE, INC
- Primary Specialty
- Durable Medical Equipment & Medical Supplies
- Enumeration Date
- Dec 1, 2022
- Last Updated
- Dec 1, 2022
Practice Location
- Address
- 3955 HARRISON RD STE 200B
- City
- Loganville
- State
- Georgia
- ZIP Code
- 30052-8502
- Phone
- (770) 209-9913
Authorized Official
- Name
- SHEVIN D POLLYDORE, MD
- Title
- PHYSICIAN/OWNER
- Phone
- (770) 209-9913
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacy |
| Durable Medical Equipment & Medical Supplies |
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