Healthcare Provider Details

I. General information

NPI: 1346000312
Provider Name (Legal Business Name): REGENERATIVE ORTHOPAEDICS AND SPINE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PARK PLACE BLVD.
GREENSBORO GA
30642
US

IV. Provider business mailing address

135 N. PARK PLACE SUITE 101
STOCKBRIDGE GA
30281
US

V. Phone/Fax

Practice location:
  • Phone: 770-892-0300
  • Fax:
Mailing address:
  • Phone: 770-892-0300
  • Fax: 470-878-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PHILIP PLOSKA
Title or Position: CEO
Credential: M.D.
Phone: 770-892-0300