Organization
COLISEUM HEALTH GROUP LLC
Active
Other names
Gray Family Health
Organization subpart
No
Provider details
NPI number
Authorized official
MICKEY PICKLER (VP)
(615) 373-7600
Entity
Organization
Contact information
Practice address
110 STONE BROOKE DR, GRAY, GA 31032-5865
(478) 986-4743
Mailing address
110 STONE BROOKE DR, GRAY, GA 31032-5865
(478) 986-4743
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN6965
RAILROAD MEDICARE
GA
Enumeration date
06/11/2006
Last updated
02/06/2008
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