| Regenesisdoc Llc | |
|
2892 Mountain Industrial Blvd Tucker GA 30084-3014 | |
| (678) 825-5757 | |
| Not Available |
| Full Name | Regenesisdoc Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2892 Mountain Industrial Blvd, Tucker, Georgia |
| Authorized Official Name and Position | Eric Mabo (OWNER) |
| Authorized Official Contact | 6788255757 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Regenesisdoc Llc 2892 Mountain Industrial Blvd Tucker GA 30084-3014 Ph: (678) 825-5757 | Regenesisdoc Llc 2892 Mountain Industrial Blvd Tucker GA 30084-3014 Ph: (678) 825-5757 |
| NPI Number | 1275047938 |
|---|---|
| Provider Enumeration Date | 11/16/2017 |
| Last Update Date | 11/16/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275047938 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
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