Healthcare Provider Details

I. General information

NPI: 1275460628
Provider Name (Legal Business Name): REVIVE SPINE AND JOINT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 REDFIELD ST STE 102
DORCHESTER MA
02122-3638
US

IV. Provider business mailing address

211 PEACHTREE CENTER PKWY SUITE 225
DUNWOODY GA
30346
US

V. Phone/Fax

Practice location:
  • Phone: 678-257-2547
  • Fax:
Mailing address:
  • Phone: 678-257-2547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SHIEL K PATEL
Title or Position: OWNER
Credential: MD
Phone: 678-257-2547