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Organization
COLISEUM PEDIATRIC AND ADOLESCENT CARE, INC
Active
Organization
COLISEUM PEDIATRIC AND ADOLESCENT CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA J TRIPPE M.D. (OWNER/PHYSICIAN)
(478) 743-4632
Entity
Organization
Contact information
Practice address
360 HOSPITAL DR BLDG D, MACON, GA 31217-3874
(478) 743-4632
(478) 743-1856
Mailing address
360 HOSPITAL DR BLDG D, MACON, GA 31217-3874
(478) 743-4632
(478) 743-1856
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
23120
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85002369G
—
GA
Enumeration date
12/19/2007
Last updated
12/19/2007
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