Healthcare Provider Details

I. General information

NPI: 1831586338
Provider Name (Legal Business Name): REGENERATIVE ORTHOPAEDICS AND SPINE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N PARK PL STE 101
STOCKBRIDGE GA
30281-7237
US

IV. Provider business mailing address

135 N PARK PL STE 101
STOCKBRIDGE GA
30281-7237
US

V. Phone/Fax

Practice location:
  • Phone: 770-892-0273
  • Fax: 470-878-1495
Mailing address:
  • Phone: 770-892-0273
  • Fax: 470-878-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PHILIP PLOSKA
Title or Position: MD, OWNER
Credential: MD
Phone: 770-892-0273