Healthcare Provider Details

I. General information

NPI: 1760436810
Provider Name (Legal Business Name): COLISEUM MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HOSPITAL DRIVE
MACON GA
31217
US

IV. Provider business mailing address

340 HOSPITAL DRIVE
MACON GA
31217-3838
US

V. Phone/Fax

Practice location:
  • Phone: 478-741-1355
  • Fax: 478-742-1247
Mailing address:
  • Phone: 478-741-1355
  • Fax: 478-742-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: ROBERT C CROSS
Title or Position: VP GOVERNMENT REIMBURSEMENT
Credential:
Phone: 470-271-3401