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Organization
COLISEUM HEALTH GROUP, LLC
Active
Organization
COLISEUM HEALTH GROUP, LLC
Active
Other names
Grace Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PICKETT (VP)
(478) 405-0280
Entity
Organization
Contact information
Practice address
420 CHARTER BLVD, SUITE 304, MACON, GA 31210-4854
(478) 405-0280
Mailing address
420 CHARTER BLVD, SUITE 304, MACON, GA 31210-4854
(478) 405-0280
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/16/2006
Last updated
08/29/2007
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