Organization
COLISEUM HEALTH GROUP, LLC
Active
Other names
Coliseum Primary Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MICKEY PICKLER (VP)
(478) 841-2707
Entity
Organization
Contact information
Practice address
360 HOSPITAL DR, SUITE 110, MACON, GA 31217-3874
(478) 841-2707
Mailing address
360 HOSPITAL DR, SUITE 110, MACON, GA 31217-3874
(478) 841-2707
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
06/07/2006
Last updated
04/20/2008
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