NPIMap

Individual provider Active NPI

Shevin Dwight Pollydore, M.D. FAAPMR

  • Physical Medicine & Rehabilitation Physician
  • Lithia Springs, GA
National Provider Identifier
1184616591
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
045588 Issued in GA
Practice address
939 Bob Arnold Blvd Ste a
Lithia Springs, GA 30122-3258
Phone
(770) 769-1724
NPI assigned
Aug 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 045588 GA Primary

Addresses

Primary practice location

939 Bob Arnold Blvd Ste a
Lithia Springs, GA 30122-3258

Mailing address

939 Bob Arnold Blvd Ste a
Lithia Springs, GA 30122-3258
Phone (770) 769-1724

Other identifiers 2

IdentifierTypeStateIssuer
00B03965HMedicaidGA
0486290001OtherDME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101207000700 GA Practitioner - Physical Medicine and RehabilitationPractitioner - Interventional Pain ManagementPractitioner - Orthopedic SurgeryPractitioner - Pain Management 6901975887 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Interventional Pain Management, Orthopedic Surgery, Pain Management
Education
Howard University College of Medicine, 1990
Medicare assignment
May accept Medicare assignment
Group practices
Revive Orthopedics Spine and Sports Medicine IncGroup PAC ID 6204271349, 3 clinicians

Practice addresses (Care Compare)

939 Bob Arnold Blvd
Suite a
Lithia Springs, GA 30122-3258
Phone (770) 769-1724

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
045588GAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Revive Orthopedics Spine & Sports Medicine, Inc Physical Medicine & Rehabilitation CurrentSince Dec 30, 2023 Accepting new patients
Peachtree Orthopaedic Clinic PA Past Accepting new patients

Locations

1750 Old Spring House Ln
Ste 205
Dunwoody, GA 30338
Phone (770) 451-4040

939 Bob Arnold Blvd
Ste A
Lithia Springs, GA 30122
Phone (770) 732-2959

3200 Shakerag Hl
Ste A
Peachtree Cty, GA 30269
Phone (770) 408-0184

45 W Crossville Rd
Ste 503
Roswell, GA 30075
Phone (678) 461-3512

Interoperability endpoints

  • Direct secure messaging: shevin.pollydore.1@27079.direct.athenahealth.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1184616591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "939 BOB ARNOLD BLVD STE A",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301223258",
            "telephone_number": "770-769-1724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 BOB ARNOLD BLVD STE A",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301223258",
            "telephone_number": "770-769-1724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLYDORE",
        "first_name": "SHEVIN",
        "middle_name": "DWIGHT",
        "name_prefix": "Mr.",
        "credential": "M.D. FAAPMR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": "045588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00B03965H",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0486290001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lithia Springs, GA

Sources for this page

Verify at the official NPI Registry.