MEDICARE: MR. SHEVIN DWIGHT POLLYDORE M.D. FAAPMR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	045588	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0486290001	OTHER		DME

General Provider Information

NPI Number	:	1184616591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHEVIN DWIGHT POLLYDORE M.D. FAAPMR

Provider Business Mailing Address
First Line	:	939 BOB ARNOLD BLVD STE A
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3258
Country	:	US
Telephone Number	:	770-769-1724
Fax Number	:

Provider Business Practice Location Address
First Line	:	939 BOB ARNOLD BLVD STE A
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3258
Country	:	US
Telephone Number	:	770-769-1724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/21/2023

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Directions to “ MR. SHEVIN DWIGHT POLLYDORE M.D. FAAPMR” Practice Location

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