Organization
COLISEUM PRIMARY CARE SERVICES, LLC
Active
Organization
COLISEUM PRIMARY CARE SERVICES, LLC
Active
Other names
Coliseum Medical Group-Northside
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE TURNER (CONTROLLER)
(843) 856-7938
Entity
Organization
Contact information
Practice address
380 HOSPITAL DR, BLDG A SUITE 370, MACON, GA 31217-8001
(478) 474-4343
(844) 664-2283
Mailing address
PO BOX 403570, ATLANTA, GA 30384-3570
(478) 474-4343
(844) 664-2283
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195942266A
—
GA
01
—
DE1497
RAILROAD MEDICARE
GA
Enumeration date
06/07/2006
Last updated
11/01/2016
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