Individual
SONG-CHU KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
308 COLISEUM DR STE 100, MACON, GA 31217-3889
(478) 742-2278
(671) 645-5549
Mailing address
308 COLISEUM DR STE 100, MACON, GA 31217-3889
(478) 742-2278
(671) 645-5549
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
01061833A
IN
2085R0001X
Radiation Oncology Physician
Primary
99225
GA
2085R0001X
Radiation Oncology Physician
M-1915
GU
2085R0001X
Radiation Oncology Physician
MD.51250
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000711556
ANTHEM PROVIDER NUMBER
IN
05
—
200826200
—
IN
Enumeration date
07/12/2006
Last updated
06/30/2025
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