REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE INC NPI 1306563663

NPI Information

NPI: 1306563663
Provider Name: REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE, INC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
939 BOB ARNOLD BLVD STE A
LITHIA SPRINGS, GA
ZIP 30122
Phone: (770) 209-9913
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REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE, INC is a multi-specialty clinic center in Lithia Springs, GA. REVIVE ORTHOPEDICS SPINE & SPORTS MEDICINE, INC NPI is 1306563663. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

939 BOB ARNOLD BLVD STE A
LITHIA SPRINGS, GA
ZIP 30122-258
Phone: (770) 209-9913
Fax: (678) 902-8579

The provider's authorized official is Shevin D Pollydore .
The authorized official title is Physician/owner and has the following contact phone number (770) 209-9913.

The enumeration date for this NPI number is 10/26/2022 and was last updated on 10/26/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207X00000X	Orthopaedic Surgery		No
2	207XX0005X	Orthopaedic Surgery	Sports Medicine	No
3	208100000X	Physical Medicine & Rehabilitation		No
4	2081P2900X	Physical Medicine & Rehabilitation	Pain Medicine	No
5	261QM1300X	Clinic/Center	Multi-Specialty	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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