Provider Demographics
NPI:1831699958
Name:REGENERATIVE SPORTS MEDICINE INC
Entity type:Organization
Organization Name:REGENERATIVE SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAADIQ
Authorized Official - Middle Name:F
Authorized Official - Last Name:EL-AMIN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:217-816-3852
Mailing Address - Street 1:2505 NEWPOINT PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6003
Mailing Address - Country:US
Mailing Address - Phone:678-257-7078
Mailing Address - Fax:336-882-0236
Practice Address - Street 1:1462 MONTREAL RD STE 109
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6904
Practice Address - Country:US
Practice Address - Phone:678-257-7078
Practice Address - Fax:678-669-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty