Provider Demographics
NPI:1184616591
Name:POLLYDORE, SHEVIN DWIGHT (MD FAAPMR)
Entity type:Individual
Prefix:MR
First Name:SHEVIN
Middle Name:DWIGHT
Last Name:POLLYDORE
Suffix:
Gender:M
Credentials:MD FAAPMR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 BOB ARNOLD BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-3258
Mailing Address - Country:US
Mailing Address - Phone:770-769-1724
Mailing Address - Fax:
Practice Address - Street 1:939 BOB ARNOLD BLVD STE A
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3258
Practice Address - Country:US
Practice Address - Phone:770-769-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045588208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00B03965HMedicaid
0486290001OtherDME
GA00B03965HMedicaid
RRBCB4505Medicare PIN
0486290001OtherDME