# COLISEUM HEALTH GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Grace Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043254360
- **Authorized official:** MARK PICKETT (VP)
- **Authorized official phone:** (478) 405-0280

## Contact information

- **Practice address:** 420 CHARTER BLVD, SUITE 304, MACON, GA 31210-4854
- **Practice address phone:** (478) 405-0280
- **Mailing address:** 420 CHARTER BLVD, SUITE 304, MACON, GA 31210-4854
- **Mailing address phone:** (478) 405-0280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/16/2006
- **Last updated:** 08/29/2007