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
—
—
Other
Enumeration date
06/16/2006
Last updated
08/29/2007
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