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Organization
REGENESISDOC LLC
Active
Organization
REGENESISDOC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC MABO MD (OWNER)
(678) 825-5757
Entity
Organization
Contact information
Practice address
2892 MOUNTAIN INDUSTRIAL BLVD, TUCKER, GA 30084-3014
(678) 825-5757
Mailing address
2892 MOUNTAIN INDUSTRIAL BLVD, TUCKER, GA 30084-3014
(678) 825-5757
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
261QU0200X
Urgent Care Clinic/Center
—
NULL
Other
Enumeration date
11/16/2017
Last updated
11/16/2017
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