Revive Orthopedics Spine & Sports Surgery Center Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

REVIVE ORTHOPEDICS SPINE & SPORTS SURGERY CENTER INC

Practice address

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

Phone

(770) 769-1724

Fax

(770) 708-6599

NPI assigned

Jul 21, 2023

Organization subpart

No

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

Authorized official

Name

Shevin D. Pollydore, MD

Title

Ceo

Phone

(770) 769-1724

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689897600000",
    "number": "1972283141",
    "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 D",
            "city": "LITHIA SPRINGS",
            "state": "GA",
            "postal_code": "301223258",
            "telephone_number": "770-769-1724",
            "fax_number": "770-708-6599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE ORTHOPEDICS SPINE & SPORTS SURGERY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "POLLYDORE",
        "authorized_official_first_name": "SHEVIN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-769-1724",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regional Home Healthcare Systems
• Monique A Reid
• Renal Life Link Inc
• Restoring the Whole U
• Revive Orthopedics Spine & Sports Medicine, Inc
• Erica Richardson
• Janelle Trivia Richardson
• Tiffany Adkins Ringfield, D.C.
• Hezekiah Tyaun Rose
• Ida Lynn Rose, DDS

• Ambulatory Surgical Clinic/Center in Lithia Springs, GA
• Providers in Lithia Springs, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.