# REGENESISDOC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275047938
- **Authorized official:** DR. ERIC MABO MD (OWNER)
- **Authorized official phone:** (678) 825-5757

## Contact information

- **Practice address:** 2892 MOUNTAIN INDUSTRIAL BLVD, TUCKER, GA 30084-3014
- **Practice address phone:** (678) 825-5757
- **Mailing address:** 2892 MOUNTAIN INDUSTRIAL BLVD, TUCKER, GA 30084-3014
- **Mailing address phone:** (678) 825-5757

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/16/2017
- **Last updated:** 11/16/2017