COLISEUM HEALTH GROUP, LLC (NPI# 1043254360) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043254360 |
| Entity Type | Organization |
| Organization Name | COLISEUM HEALTH GROUP, LLC |
| Other Organization Name | GRACE FAMILY PRACTICE |
| Practice Address |
420 Charter Blvd Suite 304 Macon GA 31210-4854 |
| Practice Telephone | 4784050280 |
| Mailing Telephone | 4784050280 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2007-08-29 |
| Authorized Official Name | MARK PICKETT (VP) |
| Authorized Official Telephone | 4784050280 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Grace Family Practice | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912947367 | Coliseum Health Group, LLC | Pediatrics | 360 Hospital Dr, Suite 110, Macon, GA 31217-3874 | 2006-06-07 |
| 1134168115 | Coliseum Health Group, LLC | Family Medicine | 3200 Riverside Dr, Macon, GA 31210-2550 | 2006-06-06 |
| Street Address |
420 CHARTER BLVD SUITE 304 |
| City | MACON |
| State | GA |
| Zip Code | 31210-4854 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508853219 | Vito John Bagnato | Surgery | 420 Charter Blvd, Suite 103, Macon, GA 31210-4854 | 2005-09-29 |
| 1790211399 | Bethesda Institute of Spine & Neurosurgery | Neurological Surgery | 420 Charter Blvd, #208, Macon, GA 31210-4854 | 2017-05-03 |
| 1992053912 | Catherine B Butler | Counselor | 420 Charter Blvd, Suite 205, Macon, GA 31210-4854 | 2012-08-23 |
| 1508120684 | Peter O. Holliday, IIi M.d. P.C. | Neurological Surgery | 420 Charter Blvd, Ste 402, Macon, GA 31210-4854 | 2012-07-03 |
| 1235498833 | Joseph Burnette, LLC | Surgery | 420 Charter Blvd, Suite 320, Macon, GA 31210-4854 | 2012-05-16 |
| 1851660443 | Palmyra Surgical, LLC | Surgery | 420 Charter Blvd, Suite 103, Macon, GA 31210-4854 | 2011-12-28 |
| 1124269089 | P O Holliday IIi Family Leasing Co LLC | Durable Medical Equipment & Medical Supplies | 420 Charter Blvd, Ste 402, Macon, GA 31210-4854 | 2009-03-23 |
| 1528231602 | Rebecca L Bass Md - Pulmonary Medicine PC | Specialist | 420 Charter Blvd, Suite 302, Macon, GA 31210-4854 | 2008-04-09 |
| 1134248149 | Alan Paul Deese | Internal Medicine | 420 Charter Blvd, Suite 405, Macon, GA 31210-4854 | 2007-03-29 |
| 1861532103 | Rebecca Lynn Bass | Specialist | 420 Charter Blvd, Suite 302, Macon, GA 31210-4854 | 2007-02-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033743455 | Dana Elizabeth Toth | Nurse Practitioner | 5300 Bowman Rd, Macon, GA 31210 | 2020-02-25 |
| 1871124735 | Jessica Bello | Nurse Practitioner | 5300 Bowman Road, Macon, GA 31210 | 2020-01-30 |
| 1225505787 | Rebekah Hollinshead | Occupational Therapist | Therapy Specialists of Georgia, 4116 Arkwright Road, Macon, GA 31210 | 2018-11-01 |
| 1346744943 | Ace Medical Transport LLC. | Ambulance | 728 Gay Dr, Macon, GA 31210 | 2018-03-20 |
| 1972965226 | Omar Faruk Ahmad | Family Medicine | 3400 Riverside Drvie, Macon, GA 31210 | 2016-03-25 |
| 1083074868 | Macon Dentist Office, PC | Dentist | 206 Tom Hill Sr Blvd, Suite 106, Macon, GA 31210 | 2016-03-07 |
| 1992176952 | Kerisia Wasztyl | Marriage & Family Therapist | 4691 Pine Valley Dr, Macon, GA 31210 | 2015-10-15 |
| 1073905444 | Eunice Malave De Leon | Social Worker | 174 Spring St, Macon, GA 31210 | 2015-02-23 |
| 1396141545 | Axis Surgery Center LLC | Clinic/Center | 230 Sheraton Blvd, Ste B, Macon, GA 31210 | 2014-11-17 |
| 1073914115 | Monique Rechelle Delay Moore | Community/Behavioral Health | 646 Millrun Court, Macon, GA 31210 | 2014-09-09 |
| Find all providers in zip 31210 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497393953 | Umerah Family Practice LLC | Family Medicine | 112 Arkwright Lndg Ste B, Macon, GA 31210-1364 | 2019-12-16 |
| 1992267892 | Andel Anthony Higgins | Family Medicine | 3780 Eisenhower Parkway, Macon, GA 31206 | 2019-04-01 |
| 1578025300 | Shail Patel | Family Medicine | 3780 Eisenhower Pkwy Ste 1, Macon, GA 31206-0801 | 2019-04-01 |
| 1972965226 | Omar Faruk Ahmad | Family Medicine | 3400 Riverside Drvie, Macon, GA 31210 | 2016-03-25 |
| 1255779351 | Kristopher K Mcjenkin | Family Medicine | 105 Bass Plantation Dr, Apt 607, Macon, GA 31210-5735 | 2013-06-11 |
| 1750620191 | Derrick Lane, Md, LLC | Family Medicine | 818 Forsyth St, Macon, GA 31201-2139 | 2013-02-05 |
| 1215182977 | Unlimited Medical Solutions, Inc. | Family Medicine | 3200 Riverside Dr Bldg B, Macon, GA 31210-2550 | 2008-11-22 |
| 1144474784 | Jack Fernando Menendez | Family Medicine | 376 Rogers Ave, Macon, GA 31204-2506 | 2008-11-10 |
| 1255504098 | Veera Pavuluri | Family Medicine | 132 Madison North Dr, Macon, GA 31220-7626 | 2008-04-11 |
| 1871770412 | Albert Warren Jr. | Family Medicine | 1339 Gray Hwy, Macon, GA 31211-1903 | 2008-01-25 |
| Find all providers in MACON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.